School-Based Medicaid Service Expansion

Due to a lack of funding, most primary and secondary schools in the United States lack sufficient health services, and particularly mental health services. The impact is even more concentrated in low-income and historically underserved schools, where students are more likely to also lack access to these services at home. This exacerbates inequities in which students have access to these essential services, with far-reaching impacts on long-term health and educational attainment outcomes. The COVID-19 pandemic has worsened these existing inequities.

As state and local governments consider their options for spending American Rescue Plan (ARP) funds, they should consider investing in an expansion of school-based Medicaid programming. A state-based policy change can unlock substantial annual federal funds flowing to local education agencies to expand Medicaid services in schools, while ARP funds can be used to cover implementation and training costs. Expanding school-based Medicaid programming can help address disparities in access to care for schools with high concentrations of low-income and historically underserved student populations, leading to long-term improvement in health and mental health outcomes. This policy change has the potential to help local education agencies get closer to the recommended ratios of mental health providers to students.

Costs will vary by state, depending on the level of support the state is able to provide, but will be limited to up-front implementation and training costs. States will be able to measure the return on investment through (1) the increase in Medicaid reimbursements, and (2) the increase in health services in schools. Though not as easy to measure, states can also expect increased mental health services in schools to lead to better health outcomes among students.