Early School Medicaid Expansions and Health Services for Children With Parental Opioid Use Disorder

An estimated 1.5 million children in the US live with a parent with opioid use disorder. Parental opioid use disorder can lead to a child experiencing unstable or harmful home environments and other adverse experiences, including parental overdose mortality, parental incarceration, and foster care placement. These children are also at heightened risk of physical, mental, and developmental issues, but are less likely to receive comprehensive, ongoing health care.  

School-based health services (SBHS) have the potential to help meet some of these health care needs through the delivery of primary care, prevention, rehabilitation, and mental health services. In 2014, the Centers for Medicare and Medicaid Services (CMS) began allowing Medicaid reimbursement for covered SBHS delivered to all Medicaid-enrolled children by qualified Medicaid providers, expanding the scope of SBHS services eligible for Medicaid reimbursement. Subsequently, states began to expand their school Medicaid programs to benefit from the new CMS rule.  

A study in JAMA Health Forum from Dr. Angelica Meinhofer and colleagues estimated the early effects of state school Medicaid expansions on the receipt of Medicaid-funded SBHS among children who have experienced parental opioid use disorder.  

Researchers evaluated Medicaid claims records for school-aged children who experienced parental opioid use disorder between the ages of zero and eighteen. They found that there were considerable increases in SBHS receipt by these children following school Medicaid expansions. SBHS growth was primarily driven by claims for Early and Periodic Screening, Diagnostic, and Treatment services as well as nursing services. Moreover, there were modest reductions in non-emergency medical transportation in school settings, and emergency room visits among the children aged five to 11.

These results have implications for both federal and state policy. The 2022 Bipartisan Safer Communities Act included funding for expanding school-based mental health services and providing technical assistance for state Medicaid agencies and school districts. However, nearly half of U.S. states have yet to expand their school Medicaid programs, and many expanding states only cover a limited set of services, providers, or children.