Sage Journals: Discover world-class research

Abstract

School nurses are important participants in School Medicaid (SM) programs nationally. Yet, the complexity of SM programs and required documentation are major barriers to implementing this program for nurses. School nurses are often required to participate in the SM program without having a clear understanding of the purpose and components of the overall program. With the expansion of SM programs due to the Centers for Medicare and Medicaid Services “free care” guidance change, nursing services and documentation are receiving more attention and scrutiny as more nursing services become eligible for reimbursement in states across the country. This article presents a clear overview of SM, its history, different components of state SM programs, school nursing documentation and challenges, and resources for school nurses who are interested in more information.

Keywords

Medicaid funding administration and management funding and reimbursement documentation data collection Electronic Health Record (EHR)

Get full access to this article

View all access options for this article.

References

Bipartisan Safer Communities Act. (2022). Pub. L. No. 117-159, 133 Stat 1313. https://www.congress.gov/117/plaws/publ159/PLAW-117publ159.pdf

Bundy

Gormley

(2022, October 24–27). School Medicaid challenges and opportunities for school nurses [Breakout session]. National Alliance for Medicaid in Education (NAME) 20th Annual Conference, Baltimore, MD, United States. https://pheedloop.com/EVERUHQZZGJJG/site/sessions/?id=SESUE11QU3XE7L31F

Centers for Medicare and Medicaid Services. (n.d.). History. https://www.cms.gov/about-cms/who-we-are/history#:~:text=for%2050%20years-,On%20July%2030%2C%201965%2C%20President%20Lyndon%20B.,economic%20security%20of%20our%20nation

Centers for Medicare and Medicaid Services. (2014, December 15). SMD# 14-006 Re: Medicaid payment for services provided without charge (free care). Department of Health and Human Services. https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf

Centers for Medicare and Medicaid Services. (2023, May 18). Delivering services in school-based settings: A comprehensive guide to Medicaid services and administrative claiming. https://www.cms.gov/newsroom/fact-sheets/delivering-service-school-based-settings-comprehensive-guide-medicaid-services-and-administrative

Healthy Schools Campaign. (n.d.). Healthy students, health futures, map: School Medicaid programs. https://healthystudentspromisingfutures.org/map-school-medicaid-programs/

Kearns Moore

Harris

. (2023, August 23). Students could get millions more in Medicaid healthcare dollars. Why aren’t they? NPR. https://www.npr.org/2023/08/24/1194170616/schools-medicaid-millions-special-education-money#:~:text=Students%20could%20get%20millions%20more%20in%20Medicaid%20healthcare%20dollars%20In,could%20be%20getting%20much%20more

KFF. (n.d.). Total Medicaid funding. https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Medicaid.gov. (n.d.). Mandatory and optional Medicaid benefits. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid/benefits/mandatory-optional-medicaid-benefits/index.html

10.

Medicare Catastrophic Coverage Care Act of 1988. Pub. L. No. 100-360, 683 Stat 817. https://www.congress.gov/100/statute/STATUTE-102/STATUTE-102-Pg683.pdf

11.

National Association of School Nurses. (2016). Framework for 21st century school nursing practice: National Association of School Nurses. NASN School Nurse, 31(1), 45-53. https://doi.org/10.1177/1942602X15618644

12.

National Association of School Nurses. (2022). School nursing: Scope and standards of practice (4th ed.).

13.

National Association of School Nurses. (2023, January). IDEIA and section 504 teams—The School Nurse as an essential team member (Position Statement). https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-ideia

14.

State of Colorado. (2023, June). School Health Services (SHS) Program Local Services Plan (LSP) guidelines. Department of Health Care Policy & Financing and Department of Education. https://www.cde.state.co.us/healthandwellness/shslspguidelines

15.

State of Wyoming. (2022, August). School-based services program. Department of Health. https://health.wyo.gov/wp-content/uploads/2022/08/SBS-Program-Fact-Sheet-8.8.22.docx

Introduction to School Medicaid for School Nurses

Abstract

Keywords

Get full access to this article

References