Medicaid helps the school fund mental health support


As a former school counselor, Curry Williams spent a lot of time getting to know her students when she became the coordinator of Honor Opportunity Purpose Excellence’s (HOPE’s) alternative learning program Edgecomb County Public Schools. He remembers that a connection was formed with one student in particular.

However, when a student violated school rules, Williams was forced to give consequences. What happened next broke his heart and opened his eyes.

“He came up to me and said,‘ What happened to you, Mr Williams? You don’t like me anymore, ”Williams recalled. “Then I realized that there really needs to be someone in my building who can help me make sure students have a safe place where they can talk, relax and learn resilience and coping skills – [someone] except myself ”.

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He needed a school social worker, but the district – like many others in the state – was no longer nationally recommended ratio. And there was not enough budget for more.

By participating in a cohort community to create a strategy, Williams found a solution that state Department of Public Education (DPI) believes this could be a solution for districts and statutory schools across the state.

Williams, using start-up grants, found a way to bill students for mental health services Medicaid and persuaded the district to provide compensation for its health and wellness program to create a sustainable social worker position.

The problem with elusive solutions is growing

Several factors exacerbate mental health problems for students today. Local heads of education, heads of state and President Joe Biden pay attention to a student mental health crisis.

But many schools lack the resources to meet the needs. For years, schools across North Carolina acted much lower nationally recommended rates for mental health support staff. In 2018, the ratio of school counselors to students in North Carolina was about 1 in 386. (The National Association of Social Workers recommends 1 in 250).

A popular solution in some areas, this is temporary funding through grants. But there is a catch in this approach.

“What will happen to the student if these funds go away?” Williams asked. “The student still needs it. I feel much worse when you get the help you need and then suddenly it disappears. Especially for students who were injured, this is another barrier for them – they say, this man just left me. “

They take a grant, but then set a plan for what will happen next

For the HOPE program, it began with addressing the question, “How can the community build a strategy around learning, treatment, and communication?” – as part of a group convened in Institute of Rural Opportunities for Sustainable Leaders Initiative in Edgecomb County.

Through this work, Williams interviewed and brainstormed community members to discover about 100 ideas that would help meet the needs of society. Williams and his team tested the ideas and reflected on the effectiveness – landing on the big for NADIA: supporting mental health in school.

The Accountability Board of the Sustainable Leaders Initiative was ready to allocate a HOPE grant to fund the position of social worker. Williams knew these funds would help students immediately. But fearing to offer a “solution for the patch,” he wasn’t sure he would accept it until he learned how to make it sustainable.

“Without Mr. Williams, we would all have embraced this idea of ​​mental health support, the accountability council would have given this grant, and their services could have looked very similar to what is happening now – but the services would have disappeared when the grant ended,” he said. Seth Sougling, co-founder of the Rural Opportunity Institute. “Thanks to Mr. Williams continue [sustainability]it just took him to a whole different level. “

Williams reached that level after a few nights fighting the problem. Why could he not replicate the system currently in place for many disability rehabilitation services? After all, schools often bill Medicaid for things like speech therapy.

How the HOPE Medicaid cost recovery model works

The process begins with a family meeting for the students named under the program. The head of the district, Valerie Bridges, includes guidelines for supporting mental health in these areas, if necessary. In such cases, Williams provides services that Marla Walker can provide in the school building during the initial family reunion.

Walker is a HOPE social worker hired through grant funding. Compensation from billing for her services at Medicaid accumulates in the money bank used to maintain her position.

Many families lack the insurance or resources to attract students to outside treatment providers during the workday, Williams said. Many families are very interested in using Walker services at school. If a student is eligible for Medicaid, Williams then records treatment services in a formalized plan and introduces a set of forms that caregivers must sign.

A formalized plan is a necessary step. In order to be eligible for Medicaid reimbursement, services must be “necessary for medical purposes” for students. Schools often use formalized plans like Individual educational plans (IEPs) or 504 plans for students with disabilities to justify mental health needs.

But many of Williams ’students do not fit that description. To formalize the need for services, he creates a Behavioral Intervention Plan (BIP) for the student, reviews the BIP with families, and introduces them to Medicaid admission forms that he has redesigned to make it more convenient for readers. Walker then connects students to an online platform, working with hundreds of codes to figure out which designation would be least restrictive for a student.

“They don’t want to label children with harsh, restrictive labels that can stigmatize or harm them – for example Opposition disapproval“Saugling said of the HOPE process. “So they try to find codes that fit the needs but have less stigma and are less restrictive.”

Once students log in to the online system and run the services, Walker invoices for the time, and the district invoices for reimbursement through Medicaid. Important step: Williams asked district leaders to create a specific code for Medicaid compensation. This code allocates money to HOPE, ensuring that the program supports funding for the social worker position.

Marla Walker of the HOPE program has designed her office for peace of mind and conversation. Rupen Phoforia / EducationNC

Providing support to each student in the school

Walker previously worked for an agency that contracted with another district to provide mental health at the school. She remembers going to these schools and meeting so many students who needed – and even wanted – her help. Her agency limited her students to her workload.

“I prayed they had something similar for the kids,” Walker said of her previous experience. “The directors tried to make me see other children, but I was not allowed to. We couldn’t do that. “

Now, even though Medicaid’s compensation will fund her salary, she is working to provide mental health support for every HOPE student.

“I think it’s the best program I’ve ever seen,” Walker said. “It works for kids. I can attend and work with all the children and I see the difference. ”

After starting work in January, she is already celebrating the victory. Walker thinks of one student who was sent to HOPE from admission to a psychiatric center after he experienced a breakdown in school. After a few months at HOPE he is preparing to return to primary school. Williams worked with the student as much as his other responsibilities before hiring Walker allowed. He said Walker had made a “big difference” with the student since her arrival.

“Now he feels ready to come back,” Walker said. “He told me he has the tools and he is ready to go back to school. That’s where the heart is, that’s the blessing in this work. As soon as a student opens that door and says, “I need to talk to you,” that’s the difference. This student knows he needs something, and they know it’s okay to ask for help. “

Can other areas repeat Medicaid reimbursement?

Williams said support from the county governor and Robert Butts, director of secondary education, contributed. He is sure they may have doubted when he first proposed the plan. However, they never reported the doubts to Williams.

“What I like about it is something innovative, something that hasn’t been done before,” Williams said. “I’m pretty sure people were afraid of what might happen because it was never done, but they supported that vision. And now you see it in vivid color and see the possibilities of what could happen. “

Lauren Holahan, coordinator of the state’s Plan for Systemic Improvement, Medicaid and School Mental Health in DPI’s Exceptional Children Division, has also strengthened intersystem collaboration across the county.

“At HOPE, they really figured out the channels of communication and role responsibilities for compensation,” she said.

In the past, Holahan has worked with Exceptional Children staff and district finance staff to maximize the benefits of Medicaid. She said that program documents governing districts and statutes number decades. The documents reflect a time when the emphasis was on funding the rehabilitation of students with disabilities. There was not so much attention to mental health and behavioral support.

But she sees no reason why other districts could not do what HOPE did.

“It doesn’t require it [being] a specialized program like HOPE to do it, ”said Holahan, who wrote her dissertation on the Medicaid program. “If we want to find a couple of supporting positions in our two high schools [public school unit]it’s a way to do it. “

This is an exciting part for Williams. He hopes others in the state will try to replicate Nadia’s success. Especially in places where grant money is funded by specialized support staff.

“I think it’s great, it’s included,” Williams said. “Everyone needs help at some point, and I would hate for someone to need help, but I didn’t have access to it. So if we can meet that need, why not? ”

Rupen Fafaria

Rupen Foforia is a reporter on equity and differences in education at EducationNC. It exists to cover, including telling stories of problems that have not been reported.

Medicaid helps the school fund mental health support

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