Letter to Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid - As School Year Begins, Bennet Urges CMS to Issue Guidance for School-Based Health Services to Address Youth Mental Health Crisis

Letter

Dear Administrator Brooks-LaSure:

In June 2022, Congress passed and President Joe Biden signed the Bipartisan Safer Communities Act to address gun violence, improve school safety, and invest in mental and behavioral health. Under Section 11003 of the act, the Centers for Medicare & Medicaid Services (CMS) has been tasked with issuing "guidance to State Medicaid programs, local educational agencies, and school-based entities to support the delivery of medical assistance to Medicaid and CHIP beneficiaries in school-based settings." Updating federal guidance regarding Medicaid funding for services in school-based settings is long overdue and urgently needed to help address the youth mental and behavioral health crisis.

Prior to the Coronavirus Disease 2019 (COVID-19) pandemic, up to 1 in 5 children ages 3 to 7 in the U.S. reported a mental, emotional, developmental, or behavioral disorder.[1] The pandemic has caused a surge in rates of depression, anxiety, trauma, loneliness, and suicidality among young people. In addition to these COVID-19 stressors, more than 140,000 children in the U.S. have lost a primary and/or secondary caregiver in the last two years.[2] In May 2021, Children's Hospital Colorado underscored how suicide has become the leading cause of death for Colorado's children and the increasing demand for health services by declaring a "State of Emergency" in youth mental health.[3] As CMS has previously found, schools can fill a critical role in identifying and connecting children with mental and behavioral health services.[4]

While Medicaid expenditures for school-based health services have increased since CMS changed its guidance on "free care" in 2014, less than half of States have expanded or started the process of expanding Medicaid coverage in schools.[5],[6] New flexibility to expand Medicaid reimbursement has led to a patchwork of policies that provide different degrees of support for school-based health services. Students of color, those from lower socio-economic backgrounds, and kids living in rural areas are most negatively affected by disparities in coverage and access to services.

I appreciate the recently released Center for Medicaid and CHIP Services Information Bulletin pointing to existing guidance and strategies,[7] however updated federal Medicaid guidance for school-based services is desperately needed. State Medicaid agencies, local educational agencies, and school-based entities need clear guidance and help reducing administrative burden to provide better support to kids during this crisis. To that end, I ask that CMS urgently work to issue the new guidance and provide my office with an expected timeline for release.

I appreciate your timely consideration of this matter.

Sincerely,

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