Illinois Receives Approval from Biden Admin for School-Based Health Services Expansion

[April 21, 2023]  SPRINGFIELD – The Biden Administration has approved a Pritzker administration proposal to expand the Illinois School-Based Health Services program, which will bring in additional federal matching funds to provide covered services for Medicaid-enrolled students across the state, including critical youth mental health services.

The expansion of the School-Based Health Services program will build on a foundation of currently-offered health care services available in Illinois schools to Medicaid-enrolled children, as well as training offered to staff, and reporting and claiming of federal matching funds that HFS does on behalf of schools.

“For many Illinois children, school isn’t just a place to learn and build skills—it’s also a place where many families can access services that are otherwise unobtainable to them, like behavioral healthcare or occupational therapy,” said Governor JB Pritzker. “Thanks to the Biden administration and my department of Healthcare and Family Services, more families will be able to access necessary healthcare and schools won’t be burdened with additional costs, making children healthier and our state stronger.”

“Schools are a critically important setting for offering health screenings and services, and especially behavioral health, to our youth in Illinois,” HFS Director Theresa Eagleson said. “This approval means that the services offered in school will be available to more Medicaid-enrolled children, which we believe will go a long way toward improving health outcomes for youth across the state.”

“Providing health care services in schools not only improves physical and mental health for students, but promotes academic success,” said U.S. Senator Dick Durbin (D-IL). “That’s why I worked on provisions in the Bipartisan Safer Communities Act and with Gov. Pritzker’s Administration to support this important federal Medicaid approval. The expansion of this program ensures every child, regardless of their background or circumstances, has the opportunity to receive the care they need to thrive in school and in life. It’s an investment in breaking the cycle of violence, and in the health and success of our children.”

The new approval allows schools to receive more funding for covered services for all Medicaid-enrolled children. School-based health services may include behavioral health services, preventive care, physical and occupational therapy and other services covered by the Medicaid program. The expansion and update to the program is expected to bring tens of millions of additional federal Medicaid dollars annually to Illinois schools.

Historically, local education agencies were only able to receive federal reimbursement for services provided to Medicaid-enrolled students who had an Individualized Education Program or an Individualized Family Service Plan, which meant reimbursement for Medicaid services in schools was limited to a small group of children.

When federal CMS reversed the decision to limit Medicaid reimbursement for services to children with IEPs and IFSPs, that meant access to benefits in a school setting could be expanded to more students with Medicaid coverage with federal matching dollars.