National Discussions on Funding for School Nurses and School-Based Health Centers Address Free Care

As various groups aligned with school-based health work to secure and identify new sources of funding for essential services, finding a solution to restrictions caused by the federal free care interpretation continues to be discussed as an opportunity for providing schools with additional federal support.


Regardless of their insurance status, children in both regular and special education programs receive school health services in public schools. Although Medicaid reimburses schools for all covered health services that are provided according to a Medicaid-eligible student’s Individualized Education Plan (IEP), the free care interpretation prohibits reimbursement for medically necessary covered health services that are provided to regular education students with Medicaid coverage if a school provides those same services at no charge to other students.

In 2002 and 2004, the free care practice was successfully challenged by the state of Oklahoma. However, the practice continues to be enforced nationally by the federal Centers for Medicare and Medicaid (CMS). It is currently being challenged by the Department of Health Care Services (DHCS) in California.

Today, as health care reform reframes the discussion around promoting cost-effective and efficient health care delivery to specific populations, stakeholders from all sides are working to find solutions to the free care interpretation that would allow schools to access federal reimbursement for the covered services being provided to regular education students with Medicaid coverage.


Free Care Highlight: Healthy Schools Campaign (HSC) School Nursing Convention, February 2012

Healthy Schools Campaign, an independent nonprofit focused on securing healthy school environments for children nationwide, partnered with Trust for America’s Health to hold a convention in Washington, DC, last February to promote discussion of the obstacles and opportunities for change associated with state and federal funding for school nurses. Attendees included representatives from the U.S. Department of Education and Health and Human Services, the National Association of School Nurses, the National Association of Medicaid Directors, and select state and Local Educational Agency (LEA) representatives as well as school-based Medicaid reimbursement program experts, including Paradigm, which was honored to participate.

A report of the proceedings and national policy recommendations, including a proposal to exempt schools from the free care interpretation, will be presented by Healthy Schools Campaign at a ceremony on May 9 in Washington, DC, to U.S. Secretary of Education Arne Duncan and Secretary of Health and Human Services Kathleen Sebelius.

– Read the Healthy Schools Campaign report and national policy recommendations…

– Read more about Health Schools Campaign’s ‘Health in Mind’ campaign series…


Free Care Highlight: California School Health Centers Association’s Annual Conference, March 2012

The California School Health Centers Association held its annual conference in Sacramento this past March, bringing together school-based health center (SBHC) providers, staff, and advocates from throughout the state. The two-day event provided dedicated time for members and attendees to discuss a range of topics, including the essential elements of funding and sustainability. Although the LEA Billing Option program is only one of several programs that SBHCs use to bill eligible services, it remains a limited contributor primarily because of the free care practice. The health community’s interest in finding a resolution for problems posed by this limitation was voiced in various workgroup and lunch seminar discussions.

– Read more about CSHC’s 2012 annual conference…