School Mental Health Financing



Medicaid Policy and School Mental Health Funding (May 2023)

Medicaid is a leading source of financing for school mental health services and programs.  Looking forward, LEAs and mental health providers may be able to bill Medicaid for more services if there is better alignment between Medicaid policies and the services provided.  In this webinar event, Dr. Adam Wilk (SE MHTTC Policy Lead) will describe key processes through which Medicaid policies can be changed to increase Medicaid funding support for school mental health services.  He will provide examples of states that have pursued specific reforms, and he will also highlight important resources that can help school mental health leaders to identify what steps may be most appropriate to take in their home state.  This session is designed for those who are interested in learning more about options for changing Medicaid policy to better support school mental health systems and services.


Financing Opportunities to Boost Mental Health Services in Schools in 2023: The Bipartisan Safer Communities Act (March 2023) 

The Biden Administration and Congress are showing renewed commitment to improving school-based mental health and substance use disorders services for young people. Through passage of the Bipartisan Safer Communities Act (2022), we expect to see new federal guidance (revising policies that have not been updated in almost 20 years), the launch of a school Medicaid technical assistance center, and $50 million in state grants. In this webinar event, Lena O’Rourke (on behalf of Healthy Schools Campaign), Orla Kennedy and Dusan Stojicic (Community Catalyst) will explain how school mental health leaders can leverage these opportunities to improve school-based health services, including meaningfully engaging young people in that process.


Medicaid and School Mental Health: A Guided Tour Through Available Resources (November 2022)

Medicaid is a leading source of financing for school mental health services and programs. In this webinar event, Dr. Adam Wilk (SE MHTTC Policy Lead) will orient attendees to nearly 20 resources – reports, infographics, webinar recordings, and more – that help to explain the role of Medicaid in school mental health financing and how to use it to pay for mental health services in schools.


Medicaid and School Mental Health 101: How Can Schools Finance School Mental Health Services through Medicaid? (March 2022)

In this foundational webinar, Dr. Adam Wilk provides an overview of Medicaid and an introduction to how Medicaid finances school mental health services. He discusses the Medicaid benefits that can cover school mental health services, what child populations can be eligible for Medicaid, what providers can bill Medicaid for school mental health services, and related considerations for schools and community mental health providers. Dr. Wilk and Allison Hu, the lead author of a new report that answers frequently asked questions about Medicaid and school mental health, conclude the webinar by answering attendees' questions.


Sustaining School Mental Health at the State-level: Panel Discussion (February 2022)

This panel discussion focuses on state-level examples of the planning, design, and implementation process that supports sustainable and scalable school mental health systems. Panelists included leaders from two state education agencies with experience navigating the changing landscape needs and availability of resources; building statewide school mental health infrastructure; and coordinating a variety of federally funded initiatives (e.g., AWARE, School Climate Transformation grants).


The Nuts & Bolts of Sustainability: Essentials for the Longevity of School Mental Health Initiatives (January 2022)

This topical learning forum is dedicated to building capacity of school and district teams invested in building long-lasting practices and policies that promote school and student mental health. In this virtual learning session, participants learned about effective sustainability practices, including strategies and tools designed to support an intentional approach to developing change that lasts.


School Mental Health Financing and Sustainability: Using Stimulus Funds to Advance Comprehensive School Mental Health (December 2021)

In this webinar, leaders from two school districts in the Southeast will join a panel to describe how they and their partners have made innovative use of Stimulus funds to finance their school mental health initiatives. The panelists discuss how their current approaches built upon prior school mental health programs and existing sources of financing, as well as how they are working towards sustainability. They also share their perspectives on how other school districts–which may be different from theirs in key respects (e.g., size, administrative capacity)–might think about the opportunities to appropriate these new funds in support of students’ mental health.


Financing School Mental Health Services during a State Budget Crisis (July 2020)

Today’s economic crisis, driven by the COVID-19 pandemic and social distancing measures, poses significant challenges for state-budget-makers. This webinar, led by health care financing expert Dr. Adam Wilk, discusses those challenges in the context of school and school district leaders’ efforts to finance school mental health programs.


Financing School Mental Health Services (August 2019)

This webinar, presented by Dr. Adam Wilk, aims to clarify how it can be determined whether a given school based mental health service will be reimbursable through Medicaid and by Medicaid Managed Care plans. Dr. Wilk also offers insights as to how school districts and school based mental health program leaders might think about Medicaid as a potentially important source of financing.



Leveraging State Plan Amendments and Medicaid Waivers to Expand School Mental Health Services in Medicaid (August 2022) 

Every state’s Medicaid program has different requirements for reimbursing school mental health (SMH) services. In many cases, expanding coverage of SMH services in Medicaid requires seeking approval from the federal government for a State Plan Amendment (SPA) and/or a Medicaid waiver to make changes to these requirements. In this short report, we introduce SPAs and Medicaid waivers, and we give examples of how states have leveraged SPAs and Medicaid waivers to expand coverage of SMH services in their Medicaid programs.


The Elementary and Secondary School Emergency Relief (ESSER) Funds and School Mental Health in the Southeast (August 2022) 

This report summarizes federal and state guidance on using the Elementary and Secondary School Emergency Relief (ESSER) funds, approved as part of multiple federal COVID-19 relief bills (2020-2021), to provide school mental health services and supports. Information about state-level guidance is focused on the eight states in the Southeast region (HHS Region 4).


What School Mental Health Services Does Medicaid Cover? (May 2022)

Medicaid can cover many school mental health services. In this infographic, we provide examples of screening services, treatment services, and supportive services for which schools can often seek Medicaid reimbursement.


Financing School-Based Services through Medicaid: Reimbursement for Administrative Expenses (September 2021)

Schools can receive Medicaid reimbursement for certain qualifying administrative activities (e.g., outreach and enrollment, supports of Medicaid-eligible direct services). This infographic highlights two broad classes of administrative activities that are often reimbursable under Medicaid.


What is Cost-Based Reimbursement? Financing School Based Services Through Medicaid (August 2021)

Many Medicaid-eligible school-based services are reimbursed under a cost-based system. This infographic provides an introduction to cost-based reimbursement systems.


How are Local Education Agencies (LEAs) Paid Under Cost-Based Reimbursement? Financing School Based Services through Medicaid (August 2021)

Many state Medicaid offices use a cost-based system to reimburse service costs and administrative costs associated with school-based service provision. Under cost-based reimbursement, LEAs and state Medicaid offices take routine actions when a Medicaid- eligible school-based service is provided throughout a quarter (or year). At the end of a quarter (year), additional actions are required to determine settlement payments. This two- page infographic walks through all of the steps these actors take both routinely and at quarter-end (year-end) to provide reimbursement under a cost-based reimbursement system.


Comparing Reimbursement Systems: Fee for Service (FFS) vs. Cost-Based – Financing School Based Services Through Medicaid (August 2021)

Medicaid reimburses most eligible school-based services through one of two systems: fee- for-service and cost-based reimbursement. This infographic illustrates how the actions of schools and state Medicaid offices between the two reimbursement systems.


The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid Benefit (October 2020)

This infographic describes the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, a rich benefit mandated to be covered in all Medicaid programs for youth (age < 21). It also highlights key common misconceptions about EPSDT.


Free Care Rule Medicaid Financing Tips (June 2020)

This infographic describes the “Free Care Rule” in Medicaid and discusses how the recently changed federal interpretation of this rule can affect local education agencies’ capacity to leverage Medicaid to finance health services, including school-based mental health services. It also includes links to key resources on the Free Care Rule change in 2014 and active state efforts to act on this change.


Using IDEA to Fund School-Based Mental Health Services (June 2020)

This infographic describes how school-based mental health services are financed under the Individuals with Disabilities Education Act (IDEA). It includes basic information about IDEA and individualized education programs (IEPs), and it offers more specific guidance around IDEA and the funding of school-based mental health services for parents, for local education agencies, and for providers.


Will Medicaid Pay For This Service? Key Constraints on Medicaid Reimbursement for School-Based Mental Health Services (August 2019)

This infographic provides an overview of key constraints on Medicaid reimbursement for school mental health services.


Distinctive Features of Medicaid Programs in the Southeast Region (August 2019)

This infographic provides an overview of key features of Medicaid programs in the Southeast.


Medicaid Managed Care and Behavioral Health Benefit Administration: Southeast Region (August 2019)

This infographic provides information about Medicaid managed care and how behavioral health benefits are administered in Medicaid programs in the Southeast.


Eligibility and Enrollment in Medicaid in the Southeast (August 2019)

This infographic provides information about Medicaid eligibility for children and child enrollment rates in the Medicaid program in the Southeast.



Medicaid and School Mental Health Services: FAQs (August 2022)

Medicaid is an important source of financing for school mental health services. In this report, we discuss how schools can finance school mental health services through Medicaid by answering some frequently asked questions. Among our answers, we describe the requirements for seeking Medicaid reimbursement for school metal health services, we discuss additional complexity in the context of Medicaid Managed
Care, and we highlight examples of how states have leveraged Medicaid State Plan Amendments and Medicaid Waivers to expand coverage of school mental health services under Medicaid.


The Southeast MHTTC created a comprehensive product catalogue of the resources and information they have published. Click here to view the full product catalogue. Additionally, these products are presented on the following pages of our website: 


Key Resources

Comprehensive School Mental Health Systems: Foundations 

Mental Health Services and Supports in Schools 

Funding, Sustainability, and Impact