Only eight of Nevada’s 17 counties are seeking Medicaid funding for student health services, and the state would like to help school districts do more to fully leverage funds available for reimbursement and assist with children’s increasing needs.
In January this year, Carson City, Churchill County and Lyon County school districts were approved for Medicaid reimbursements in the amount of $2,018,299, $940,000 and $887,882, respectively, to be disbursed in quarterly amounts in fiscal year 2022-23.
Authorizations were made by the State Board of Examiners, which consists of Gov. Steve Sisolak, chairman, and members Attorney General Aaron Ford and Secretary of State Barbara Cegavske.
The school-based funding obtained for the School Health Services program includes medical screening, diagnostic and treatment services and is overseen by the Nevada’s Department of Health and Human Services. It is jointly funded by state and federal agencies to assist lower-income populations from children to seniors.
It underwent revisions in March 2020 when it was called the “School Based Child Health Services” program and had certain other language changed to allow state education agencies to provide medical services in schools.
“Way back, the federal government knew it doesn’t fund at the level for (Individual Education Plans), so I believe the intent was for districts to recoup some of the services we provide for our students,” according to Carson City School District’s Christine Lenox, director of student support services.
Medicaid was established in 1965 as a basic insurance program to help Americans gain access to affordable health care and has been tailored throughout the years. The goal in the educational setting has been to expand health amenities in schools where more medical screenings and diagnostic services can be offered in a convenient situation for families and students.
“Accessing health care can be a challenge for vulnerable populations,” said Nevada Medicaid Administrator Suzanne Bierman. “To meet that challenge, Nevada Medicaid is one of a number of states expanding Medicaid-funded services available in schools where it is convenient for students and families. Nevada Medicaid supports further adoption of the program by remaining school districts.”
The Centers for Medicare and Medicaid Services issued a letter in December 2014 that reversed its “free care” policy and allows schools to bill Nevada Medicaid for services recorded in an Individualized Education Program. The change impacted Nevada Medicaid’s ability to service students who were eligible without an IEP, which can act as a plan of care.
But according to Lenox, whether or not the reimbursements from these Medicaid programs come, the services will continue, no matter what.
“Whether we have this funding or not, we’re going to provide services,” Lenox said. “This would never dictate whether a service is provided or not.”
Medically necessary services listed in a student’s plan of care are intended to meet their health needs and reduce any physical or mental impairment. School districts providing services or evaluations through the Individual Education Plans, created under U.S. law for each public school to assist eligible children in need of special education, will tailor teams with parents and school staff members to help with the child’s specific learning disability or impairment.
In the school’s most basic team evaluating the child’s need, according to Lenox, team members include the general education teacher, special education teacher and parent. As a need and the IEP are assessed annually, others might be included on the team, such as a speech language pathologist, occupational therapist or a behaviorist. Members review the student’s progress and every three years, the team discusses eligibility for services.
“If the child has a deficiency in the area of language or expressive language, we need to program around that,” Lenox said. “We come up with this plan and then it’s implemented. Your speech pathologist would be working with this child in the manner your team’s decided on in a specific goal, and they log the work they’ve done and sign off with the time.”
For students who have more specialized needs – medical or nursing services, for example – the district will contract with third-party consultants or administrators such as implementation and operations firm Public Consulting Group, headquartered in Boston. The company specializes in education, health, human services and technology consulting, giving school districts online access to programs to track billing and compliance to relieve time constraints in some situations, Lenox said.
Carson City School District has been working with PCG for some time.
“Before I did this job, I did speech pathology, and I would see my students, put my notes (in the system), and it went straight up to the company who manages it,” Lenox said.
With approximately 1,110 students in Carson City now who are on an IEP, not every student receives every service, Lenox said. She’s also never had a parent turn down the services when asked.
“The child gets what they need, no matter what,” Lenox said. “It’s on the back side where we see the benefits. It doesn’t impact our general education fund as much. … Nothing would change for our students. We would still provide the work being done by the IEP team.”
In January, the Nevada Board of Examiners approved the reimbursements for the Carson City, Churchill and Lyon school districts that will be applied to their non-federal portion of school health services, medical screening and diagnostic services for children eligible for Nevada Medicaid or Check-Up programs.
For Lyon County School District, Superintendent Wayne Workman, whose executive cabinet includes Executive Director of Special Services Marva Cleven, Executive Director of Operations Harman Bains and grants manager Cindy Routh, the program has been beneficial to local students. Lyon County, as of 2020-21, had a total enrollment of about 8,817 as of 2020-21 and 1,218 students in its IEP program, according to nevadareportcard.nv.gov.
“We are extremely grateful for the increased flexibility that has been provided to school districts with Nevada Medicaid as we are now able to provide more services to students than ever before,” Workman said.
Lyon has participated in school-based Medicaid programs for a number of years, according to Cleven. The agreements enable schools to bill services for Applied Behavior Analysis for students with autism spectrum disorder, audiology, medical nutritional services, mental or behavioral health services, personal care, occupational therapy, physical therapy, physical and behavioral health screenings and speech therapy, she said.
“It's important to note that services provided in the school setting do not impact the benefits of students outside of the school setting,” Cleven said. “They continue to have full benefits of their Medicaid programs.”
But why not all school districts have chosen to apply for the repayments is unknown, said Ky Plaskon, spokesman for the Nevada Medicaid program of the Nevada Department of Health and Human Services. The program was the third-largest source of federal funds for K-12 education in 2019, and even then, a survey from the American Association of School Administrators had found 84 percent of districts not seeking reimbursements for school-based health services were rural, according to Education Week.
“Some districts don’t know how easy it is,” Plaskon said.
As a Nevada district works with Medicaid through its process for participation, the contract is brought before the State Board of Examiners once every four years for approval.
School districts that would like to participate are invited to write to firstname.lastname@example.org.