Academic journal article Journal of School Health

Incorporating Expanded School Mental Health Programs in State Children's Health Insurance Program Plans

Academic journal article Journal of School Health

Incorporating Expanded School Mental Health Programs in State Children's Health Insurance Program Plans

Article excerpt

The State Children's Health Insurance Program (CHIP), codified as Title XXI of the Social Security Act, was passed into law in 1997 as part of the Balanced Budget Act.[1] This program provides states with unprecedented control over disbursing up to $40 billion in federal health insurance dollars over a 10-year period.[2] States participating in CHIP may purchase health insurance for children in families with higher income levels than those receiving medical assistance (up to about 200% above poverty level). Thus, some 3 million children, or approximately 33% of the uninsured children in this country, can receive insurance coverage under CHIP.[2,3] This program will provide health insurance for children in families with parents who work, but whose earnings disqualify them for other federal programs because they are too high. To enter the program, states write plans for enrollment, reimbursement, and service delivery that are then approved by the Health Care Financing Administration.[4]

CHIP was developed to provide services to uninsured children, such as adolescents and Hispanic youth. School-based health centers (SBHCs) and other programs offering expanded school mental health (ESMH) services provide care for children who would otherwise have limited or absent access to mental health care.[5] Therefore, they provide optimal enrollment and outreach sites as well as primary care settings for providing services for children, who are eligible for or are receiving CHIP coverage.[6,7] Becoming active players in the development of CHIP plans provides opportunities for ESMH programs to enter the fee-for-service managed care environment and expand their activities in this arena.[8] Many states are using their medical assistance (MA) infrastructure as the conduit for disbursing CHIP funds, while others are providing reimbursement of CHIP funds through health care plans or managed care organizations (MCOs).

Several excellent reviews providing ideas for thriving in this era of managed health care are available.[6,7,9,10] In addition, Armbruster and colleagues[11] provided thoughtful suggestions for ESMH programs interested in developing working relationships with MCOs. However, when we began this research, reviews with suggestions specifically for ESMH programs interested in accessing CHIP funds were lacking.

This project evolved from ideas presented at an annual critical issues meeting sponsored by the Center for School Mental Health Assistance (CSMHA).[12] The purpose of these meetings has been to convene a panel of national experts to discuss important topics and future directions for the ESMH field. At this meeting, national experts discussed critical funding issues, such as the importance of involving ESMH programs in state CHIP plans, and suggested that a national study be conducted through the CSMHA.

This paper presents a synthesis of information from a literature review and results from a survey in which persons representing key stakeholder groups across the nation, such as state CHIP directors and administrators from health departments, completed phone interviews to document their ideas for incorporating ESMH programs in state CHIP plans.[13] Copies of the phone interview are included in an Issue Brief titled "Involvement of Expanded School Mental Health Programs in the State Children's Health Insurance Program (CHIP)" and distributed by the Center for School Mental Health Assistance (CSMHA, 1-888-706-0980).

The interviews addressed several topics. For example, information about enrollment activities currently being conducted in schools was obtained. Additionally, in response to interview questions, stakeholders discussed the benefits and challenges for ESMH programs participating in CHIP plans. They reported significant difficulties, typically in terms of enrolling clinicians in schools on MCO plans (contracting as providers) and meeting billing requirements. Stakeholders also provided suggestions for incorporating ESMH programs in CHIP plans. …

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