Advocates' Guide To The Change In The Medicaid Free Care Rule

Dear Partners,

Children living in low-income communities face a myriad of challenges associated with health care access. According to Kids Count data, one in seven children in the United States lives in a high poverty neighborhood—where poverty rates are more than 30 percent. African American children are twice as likely to live in high poverty neighborhoods. Poverty and health are inextricably linked; ensuring low-income children have access to health services is vital. Despite Medicaid covering more than one in three children in the United States, access to health services remains a problem for low-income families who are often working multiple jobs and rely on public transportation. Steep inequities and barriers to health care persist. We must rethink how and where children access needed health care. There is a new opportunity to meet children where they are - in schools.

In December 2014, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director letter that provides clarification of the “free care” rule that once limited schools’ ability to bill Medicaid for Medicaid-eligible services. Schools now have an opportunity to be reimbursed for health services provided to Medicaid-eligible children, regardless of their participation in special education programs. To date, only a few states have taken the steps needed to implement the change in policy; advocates have a role to play in activating states to take action.

We wanted to share a few resources to support advocates in leveraging this rule change. In the following toolkit, please find:

  • An overview of the change in the free care rule that includes background of the program, the link between care and education, and the opportunities provided by this rule change
  • Strategies to advance states’ efforts to implement the free care rule change
  • A stakeholder guide that identifies helpful allies in advancing the free care policy clarification, including key messages

Additionally, below are some partner resources to help advocates advance a school health agenda around this issue:

If you have any questions or want to talk more about these resources, contact Eva Stahl:

Thank you for your continued advocacy,

Community Catalyst Children’s Health Team

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