Implementation and expansion of Medicaid claiming for school based behavioral health services in all 24 jurisdictions in the state of Maryland, under new CMS guidance to improve access to care. - Blueprint to Building: Implementation of Medicaid School-Based Services for Maryland’s Future–Project Abstract Ensuring school-aged children have access to comprehensive health services during a formative time of their lives is a principal goal of the Maryland Medicaid program. School-aged children (those under the age of 19) make up over 40 percent, or 700,000, of Maryland Medicaid’s total enrollment. With Medicaid as the main source of health care coverage for three in eight children in Maryland, the Maryland Department of Health (MDH) envisions behavioral health for children and adolescents as a continuum that is supported by investment in data, quality care, health equity and workforce initiatives. Maryland seeks to leverage recent CMS guidance and implement Medicaid school-based behavioral health services for all children, which was previously restricted to children with an IEP or IFSP. Children and youth have a number of unmet behavioral health needs. According to the 2021-2022 Maryland Youth Risk Behavior Surveillance System, 39 percent of high school students and 37 percent of middle school students felt sad or hopeless for at least two weeks; 21 percent of high school students considered suicide; and 12 percent of high school students reported that a parent or other adult yells at them or puts them down. Schools provide a protective factor, where 77 percent of high school students and 81 percent of middle school students felt comfortable seeking help from school staff (Maryland State Department of Education (MSDE), 2022). State Medicaid Agencies and State Education Agencies have an opportunity to build on this trusted relationship and alter the trajectory of behavioral health outcomes for children. Under the auspices of 2021 landmark legislation called Blueprint for Maryland’s Future, interagency collaboration has positioned Maryland to implement and expand the provision of school-based behavioral health services in Medicaid and leverage a broader strategy to transform the state education system, reducing achievement gaps and ensuring opportunity for every student, regardless of family income, race, ethnicity, or ability (MSDE, n.d.). In addition to increasing access to behavioral health services in schools, Medicaid school-based claiming serves as an additional investment to support Blueprint implementation, ultimately providing schools and local education agencies (LEAs) with a new funding stream. Maryland expects to experience increased utilization of these services by: 1) building out infrastructure; 2) encouraging additional LEAs to offer school-based services; 3) training LEAs in documenting and billing for these services inclusive of allowable administrative costs; and 4) educating the public in the benefits of school-based services. The total budget requested for SBS implementation activities is $2,497,601 over the course of three project years. MDH will adopt a phased approach to fully leverage the 2023 CMS guidance in implementing school-based services. In Phase 1, MDH will implement fee-for-service reimbursement of LEAs and other provider types. In Phase 2, MDH will build the infrastructure for reimbursement for administrative costs. MDH will devote use $1.7 million over the life of the project towards a dedicated SBS resource at MDH’s behavioral health administrative services organization; a vendor to support the preparation of a scope of work for the work associated with developing cost report templates and instructions; a vendor to support the development of the SBS Time Study Claiming Implementation Plan; and a communications vendor. The budget also includes funding for new positions at MDH dedicated to SBS implementation, as well as an allocation for the dedicated team to attend the National Alliance for Medicaid in Education Conference.
