Iowa schools could see health services boost due to federal policy change

A recent federal policy reversal, long-sought by states and health care advocates, could enable schools to take a lead role in managing chronic childhood diseases and result in the hiring of many more school nurses.

School districts in the Corridor might not see effects that dramatic, but the change could allow them more budgetary flexibility and lead to increased mental health services, school officials said Tuesday.

The change, announced unexpectedly last month by the Centers for Medicare and Medicaid Services (CMS), will allow public schools to receive Medicaid money for health services they provide to eligible students for the first time since 1997.

Once several financing and bureaucratic hurdles are cleared, advocates believe the new policy will improve the coordination of care provided to children with conditions such as asthma, diabetes, and mental illness.

It will be especially important, they said, for low-income kids who are less likely to have comprehensive medical coverage.

Matt Townsley, Solon Community School District's director of instruction and technology, said Solon schools likely would not hire additional nurses or provide more services, but he said the change would give the district more flexibility in how it pays for existing services.

'There are students that have health needs, and right now it's essentially up to the local school district to pay for all of the nurses' time,' Townsley said. 'This could allow us to capture some of that money.'

The Solon district has done a total of about $150,000 in Medicaid billing over the past four years, Townsley said. Most of that money, he said, covers costs associated with caring for physically disabled students.

In addition to two school nurses, the district employs paraprofessionals who help disabled students at mealtime and with other non-academic needs throughout the school day, Townsley said.

Medical services for Iowa special education students were already covered before the policy change, said Amy McCoy, a spokeswoman for the Iowa Department of Human Services. The state is still reviewing the new policy, McCoy said, but it does not anticipate a large fiscal impact on Iowa's Medicaid program.

The Solon district likely will increase its Medicaid billing as a result of the policy change, Townsley said.

Katie Mulholland, the superintendent of the Linn-Mar Community School District, said the new policy likely would help the district increase its mental health services for students.

Some Iowa districts and advocacy groups have made mental health services a legislative priority this year, saying they don't have enough funding to adequately treat students with mental health issues.

Sarah Pinion, the Marion Independent School District's superintendent, said she was not yet sure how the new policy would impact Marion schools.

Other Corridor districts either said they had not heard about the policy change or did not return requests for comment.

'It's still so early'

The policy change had been sought for at least 10 years by states and advocacy groups working in the area of children's health. CMS declined to comment, beyond the letter it sent to state Medicaid directors announcing the decision.

'It's still so early, a month into the rule changes, but this represents a tremendous opportunity to address children's health needs,' said Mary-Beth Malcarney, an assistant research professor at the George Washington University School of Public Health, whose work was used by the coalition of advocacy groups that pushed CMS for the change.

The issue arose in 1997 when the Health Care Financing Administration (HCFA) — now the CMS — said Medicaid would no longer pay for services provided for free to the general public.

For example, if a school district provided free vaccinations to all its students, that district could not bill Medicaid for immunizing Medicaid-eligible children, even though Medicaid would cover the immunization in a doctor's office or community health center.

Exceptions were allowed for some children with disabilities.

Schools could work around the rule by charging non-Medicaid children for the same services, generally by billing their private insurers or, if they had no insurance, charging their families directly.

But that placed a burden on the schools, which are not equipped to handle insurance billing. Also, many private insurers do not recognize schools as providers of medical care.

HCFA's reasons for enacting the so-called 'free care policy' have become hazy over time. Before the policy, government auditors had frequently cited school districts for improper Medicaid billing.

There also was a view at the time that Medicaid was somehow being victimized when non-Medicaid eligible children were receiving the same services for free.

Through the years, advocates for children's health, particularly those concerned about childhood asthma, continued to urge CMS to abandon the policy. GWU's Malcarney said they were helped by a growing conviction in public health that medical services need not be delivered exclusively through a clinician's office, but also in places where people live, work, play and learn.

'Children don't park their chronic diseases outside the school doors,' said Donna Mazyck, executive director of the National Association of School Nurses, one of the member groups in the Childhood Asthma Leadership Coalition. 'If they have asthma outside school, they have asthma inside school.'