ForHealth Consulting School-Based Claiming Services Helps with New CMS Guidance (Updated)

In June 2024, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced up to $2.5M in grant awards to 18 states for the implementation, enhancement, and expansion of  Medicaid and CHIP School-Based Services.

School districts or local education agencies (LEAs) provide health-related services that support students’ ability to achieve educational goals. While CMS allows states to seek federal reimbursement for public expenditures by LEAs for the cost of providing health-related services, there is still untapped potential for federal reimbursement for direct services and Medicaid administrative activities provided at schools, such as physical and occupational therapy, psychological and counseling services, health-related screenings, nursing, speech/hearing/language services, Medicaid outreach, and care coordination.

New CMS guidance issued in May 2023 poses new options and requirements for schools to participate in federal reimbursement. Most importantly, it encourages states to design effective CMS reimbursement programs. The new guidance created new grant funding and programmatic flexibility, which will enable more states to better meet the health-related needs of children in school.

With three decades of experience in school-based Medicaid programs, ForHealth Consulting’s industry-leading experts can design reimbursement models and programs that can support states in the design, implementation, and ongoing administration phases of their programs. Our consultants’ experience can help states understand the new guidance and how the states can create and operate programs to maximize this funding opportunity to better support their children and youth in school.

ForHealth Consulting offers a robust, comprehensive suite of school-based claiming services, along with our expert guidance. Learn more about how we can help you.