Using New Federal Funding to Meet Children’s Behavioral Health Needs in School

Since the pandemic began, there has been an increase in suicide rates among young people, particularly Black adolescents. Rates of attention-deficit/hyperactivity disorder, anxiety, and depression have also continued to rise as the long-term impact of COVID-19 plays out. Seven of 10 public schools report that the number of students seeking mental health services has increased since 2020. With students back in the structured environment of school, educators are working overtime to meet their behavioral health needs. Fortunately, the federal government has responded with unprecedented levels of support and efforts are underway to help schools put these new or dramatically expanded resources to good use.

The American Rescue Plan Act’s (ARPA) Elementary and Secondary School Emergency Relief (ESSER) provides more than $122 billion to help pre-K through grade12 students recover from lost time in schools by supporting their mental health, as well as their social, emotional, and academic needs. Additionally, the Bipartisan Safer Communities Act of 2022 commits more than a billion dollars in the next five years to support schools in addressing youth behavioral health needs, including funding for school mental health workforce. The law also directs the Department of Health and Human Services (HHS) and the Department of Education (DOE) to create a technical assistance center that will help states and schools better use Medicaid dollars for school-based services. In July 2022, DOE and HHS issued a joint letter to governors encouraging partnerships at state and local levels and outlining resources to support youth with behavioral health needs.

Some states and school systems offer promising models — for example:

• Onondaga County, New York, is using ARPA funds to staff schools with 64 new mental health professionals
• New Hampshire is partnering with the Centers for Disease Control and Prevention to expand school health clinics and is requiring clinics to provide behavioral health screening, counseling, and crisis response
• Utah is using its SafeUT app to allow guardians and educators to text and chat with students to help deescalate crisis situations and then connect students to supports.

Maximizing School-Based Medicaid

Funding is sorely needed, but policy support is also necessary for schools to take advantage of resources. More than half of public schools lack a full-time school counselor. Fewer than 20 percent of 13-to-16-year-olds with mental health issues receive the help they need; and the majority of these youth (80%) receive that care in a school setting. As of March 2022, only 17 states had chosen to expand their school-based Medicaid programs, which allow them to reimburse for school-based mental health staff who work with students covered by Medicaid. In 2019, the School Superintendent Association found that a quarter of rural districts no longer participated in the program because they lost money as a result of the cost burden of complying with paperwork and administrative requirements. A recent Medicaid informational bulletin has signaled to states the need to support youth mental health in schools and “ease administrative burden.”

Since schools are not designed to navigate the complexities of health care billing, the technical assistance center created through the Bipartisan Safer Communities Act could prove to be a significant factor in translating federal intention into systemic change and funneling much-needed ongoing revenue into schools for mental health services. The center can provide much-needed technical assistance around Medicaid billing and documentation and assist states with simplifying Medicaid licensure requirements for schools.

Conclusion

Strengthening schools with funding to support young people’s mental health is critical. With additional Medicaid and ARPA ESSER funding, we are seeing states and schools create new and robust opportunities to address youth mental health needs. Supported by collaboration across systems, this funding can enable schools to offer accessible, effective behavioral health supports to their students.