School-based services

The Office of Superintendent of Public Instruction (OSPI) is the primary agency charged with overseeing public K–12 education in Washington state. Working with the state's 295 public school districts, charter schools, and 6 state-tribal education compact schools, OSPI allocates funding and provides tools, resources, and technical assistance so every student in Washington is provided a high-quality public education.

Learn more about Washington school districts.

About school-based services

Background

School-based services (SBS) are Medicaid-covered health care services provided to students in Washington state public schools. These services include:

• Public school districts Medicaid administrative claiming (MAC)
• School-based health care services (SBHS)
• Schools contracting with managed care organizations (MCO)

School-based services updates

School-based services expansion

In response to the Centers for Medicare and Medicaid’s (CMS) recently released guide for delivering services in school-based settings, the Health Care Authority (HCA) established a chartered workgroup to:

• Evaluate HCA’s existing SBS Medicaid programs and make recommendations to ensure compliance with the CMS SBS Guide.
• Complete an assessment to inform recommendations and implement improvements regarding SBS.

Community engagement sessions

School-based services resources

Federal resources

• CMS overview of Medicaid and school-based services
• CMS Delivering Services in School-based Setting guide
• CMS guide fact sheet
• Technical Assistance Center (TAC)
• CMS SBS TAC upcoming events
• CMS SBS TAC frequently asked questions
• US Department of Education and School-based Services

Other resources

• National Association of Medicaid Directors (NAMD) Medicaid funding for school-based services
• National Alliance for Medicaid Education (NAME) resources school-based services
• Healthy Students, Promising Futures
• Healthy Students, Promising Futures Medicaid fact sheet

Public school districts Medicaid Administrative Claiming

Medicaid Administrative Claiming (MAC) is a program available for governmental entities that interact with individuals who are, or may be, eligible for Washington Apple Health (Medicaid).

The Public School District MAC program provides public schools with partial reimbursement for the time their staff spend performing administrative activities that support the State's Medicaid Plan, such as:

• Apply for Apple Health, including renewals.
• Explaining the Apple Health program.
• Helping individuals access Apple Health services.

How can I participate?

To participate in the program, you must:

• Be a governmental entity.
• Be contracted with HCA.
• Participate in a time study designed to identify the percent of time you spend performing the Medicaid administrative activities listed above.

Learn more about MAC for public school districts.

School-based health care services

School-based health care services (SBHS) is an optional Apple Health program that provides reimbursement to public schools for certain early intervention health-related services or special education health-related services. This program is fee-for-service and is not covered through managed care.

SBHS reimburses contracted school districts, educational service districts (ESD), charter schools, and tribal schools for Apple Health covered services provided to students with Title XIX (19) Medicaid (CNP/MNP) coverage and the services are included in the student's current individualized education program (IEP) or individualized family service plan (IFSP).

Learn more about SBHS.

School-based health care centers

School-based health centers (SBHC) are student-focused health centers located in or near schools. SBHCs are often primary care providers and bill similarly for services rendered in partnership with schools.

School-based Behavioral Health Services and Billing Toolkit

The Medicaid School-Based Behavioral Health Services and Billing Toolkit provides guidance on how public schools can access Medicaid funding for non-Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) school-based behavioral health services through the Medicaid managed care organizations and fee-for-service programs.

The toolkit also provides behavioral health resources and supports, directions on how to become a behavioral health agency, and best practices for billing Medicaid.

The toolkit is focused on reimbursement for behavioral health services, but public schools may also be able to receive reimbursement for other non-IEP Medicaid-covered services provided in the school setting. Public schools are encouraged to discuss other covered services with MCOs.

Schools contracting with managed care organizations

Public schools can contract directly with the Medicaid managed care organizations (MCO) to receive reimbursement for providing Medicaid-covered health services not included in an IEP or IFSP.

Examples of services that public schools may receive reimbursement for include:

• Vision and hearing screenings
• Diabetes and asthma treatment for students with 504 plans
• Behavioral health services
• Immunizations
• Any other non-IEP/IFSP Medicaid-covered health service

Learn more about contracting with managed care organizations.

Division of Behavioral Health and Recovery (DBHR) school-based programs

The Division of Behavioral Health and Recovery (DBHR) School-Based Programs support students' mental health and well-being through comprehensive services and resources delivered within educational settings.

Project AWARE

Project AWARE (Advancing Wellness and Resilience in Education) is all about improving mental health support in schools. It helps students by identifying and addressing their mental health needs early on, preventing issues before they become bigger problems. The project brings together schools, families, and community groups to create a caring and supportive environment for students. By working together, we can help students build resilience, stay well, and reach their full potential. Project AWARE is here to make sure every student has the support they need to succeed.

Health Care Authority supports Project AWARE by working closely with the Office of Superintendent of Public Instruction (OSPI). This partnership helps align our Behavioral Health Systems and develop policies that enhance mental health support in schools.

Federal Match Grant

The Federal Match Grant provides funding to support local projects by matching federal dollars with state or local funds. This grant helps amplify the impact of local initiatives, ensuring that projects have the necessary resources to make a meaningful difference in the community. By combining federal support with local investment, the Federal Match Grant enables a collaborative approach to addressing important community needs and enhancing the effectiveness of local programs.

Mobile Response and Stabilization Services (MRSS)

Mobile Response and Stabilization Services (MRSS) is designed to meet the unique needs of children, youth, young adults, and their families. In MRSS, the family or young person identifies what constitutes a crisis, and the team responds accordingly. This approach helps keep young people in their homes and communities, reducing trips to the emergency room, avoiding unnecessary involvement with law enforcement, child welfare, or costly out-of-home placements.

MRSS teams provide in-person help, offering crisis de-escalation, risk assessment, and safety planning tailored to each family's needs and strengths. They also work closely with other child-focused systems to improve access to care and reduce barriers. MRSS includes a stabilization phase lasting up to eight weeks, during which the team continues to support the family with skill-building, care coordination, and referrals to additional services. This phase helps prevent future crises and improves long-term outcomes for the youth and their families.

Kids Mental Health WA

Kids Mental Health WA supports regions in Washington State in three key areas:

• Establishing community-wide teams to aid children, youth, and families.
• Creating an access portal for individuals to request support for a child or youth.
• Convening multidisciplinary teams from the community to develop stability plans and resource access for children and families.

Health Care Authority (HCA) is partnering with the Behavioral Health Administrative Service Organization, Kid’s Mental Health Pierce County, and the Department of Developmental Administration (DDA) to implement this program in three regions per year over the next three years.

The Bridge

The Bridge is a statewide collaboration between community-based housing providers, behavioral health discharge planners, other community-based professionals, and young people with lived experience. The group aims to increase the number of unaccompanied young people who return to community with safe housing and services upon exiting an inpatient behavioral health setting.