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Context & Background
In 1997, the Colorado General Assembly passed legislation that authorizes public school districts, Boards of Cooperative Education Services, and state K-12 educational institutions to provide health services to children by using reimbursed Medicaid funds.
The intent of this legislation is to:
- Support and enhance local school health programs
- Increase access to preventive and primary health care services for low-income, uninsured, and underinsured children
- Improve care coordination between schools and health care providers
The program has two different and exclusive components; receiving reimbursements from the federal government for providing Individualized Education Plan (IEP) health services to Medicaid enrolled students and using these funds health services to all students. The statute allows districts to be reimbursed through federal matching funds for IEP health services provided by Medicaid qualified providers to Medicaid eligible students during school hours. Matching funds are required to be used to enhance health services for all children. Funds are intended to enhance, expand, or support the availability of health services to students. The legislation allows for up to 30% of these reimbursed funds to be used for initiatives to increase access to health care for low-income students.
In December 2014 Centers for Medicare and Medicaid Services (CMS) reversed their decision of not allowing Free Care (services provided to Medicaid enrolled students at no charge, and/or provided to the community at large free of charge) to be reimbursed. This reversal means Medicaid eligible services provided to enrolled students are available for reimbursement if all other Medicaid requirements are met.
In October 2020 the SHS Program expanded to include program covered services reimbursable to districts and BOCES for Health First Colorado enrolled students with other medical plans of care (outside of IEPs/IFSPs) where medical necessity has been established.
To receive Medicaid reimbursement, each school district/BOCES which enters into a contract with HCPF on behalf of the state of Colorado must:
- Assess the health care needs of its students, including an assessment of the needs of uninsured and underinsured students
- Obtain and incorporate community input to establish health priorities
- Develop an LSP according to guidelines issued by the Colorado Department of Health Care Policy and Financing (HCPF) and the Colorado Department of Education (CDE)
Required elements of the plan are covered in detail in subsequent portions of this section. In general, they include:
- Determining the health needs of students, including a targeted needs assessment for uninsured and underinsured students
- Soliciting input from members of the community to determine local health needs via:
- School Health Advisory Committee with cross section of community members
- Survey sent to principals, mental health providers, parents, public health Healthy Communities staff, public health registered nurses, homeless services, community-based healthcare providers and other community-based advocacy groups
- Determining the amount of reimbursement available from HCPF Cost Reconciliation Report
- Community partners prioritizing health needs as determined by needs assessment
- Describing and listing the health services to be provided based on community input and needs assessment
- Describing how funds will be allocated for these health services as determined by community partners
- Establishing procedures for monitoring and reporting the delivery of these health services
The Local Services Plan is an important document that requires recreation every five years. LEAs have the option to revise as needed during this period. Periodic reviews ensure that the health services provided remain relevant and responsive to the needs of the local community.