School-based services
Apple Health (Medicaid) and the Children’s Health Insurance Program (CHIP) provide health coverage to nearly 800,000 children in Washington. Find information and resources for health care services in public schools, including Medicaid Administrative Claiming (MAC), School-Based Health Care Services (SBHS), and efforts to expand access to Medicaid-funded physical and behavioral health services for eligible students.
School-based services Medicaid modernization update
The Health Care Authority (HCA) and the Office of the Superintendent of Public Instruction (OSPI) are modernizing school-based Apple Health (Medicaid) services, including:
- Simplifying Medicaid claiming.
- Reducing burden.
- Expanding eligible services and providers.
- Using Random Moment Time Study (RMTS) for all staff, instead of individual billing.
These updates align with the Centers for Medicare and Medicaid Services (CMS) Delivering Services in School Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.
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Get updates about school-based services
The Office of Superintendent of Public Instruction (OSPI) is the primary agency charged with overseeing public K–12 education in Washington state. Working with the state's 295 public school districts, charter schools, and 6 state-Tribal education compact schools, OSPI allocates funding and provides tools, resources, and technical assistance so every student in Washington is provided a high-quality public education.
Learn more about Washington school districts.
Learn more about Medicaid in schools from OSPI.
School-based services expansion
In 2023, the Centers for Medicare & Medicaid Services (CMS) released updated guidance to expand Medicaid services in schools. The Health Care Authority (HCA), in partnership with the Office of Superintendent of Public Instruction (OSPI), received a federal grant from CMS to support the expansion of School-Based Services (SBS) in Washington.
This work expands access to Medicaid-funded physical and behavioral health services for students and creates a single comprehensive SBS program. The program will allow school districts to bill Medicaid for eligible services provided to students enrolled in Apple Health using a cost-based reimbursement method.
Public school districts Medicaid Administrative Claiming
Medicaid Administrative Claiming (MAC) is a program available for governmental entities that interact with individuals who are, or may be, eligible for Washington Apple Health (Medicaid).
The Public School District MAC program provides public schools with partial reimbursement for the time their staff spend performing administrative activities that support the State's Medicaid Plan, such as:
- Apply for Apple Health, including renewals.
- Explaining the Apple Health program.
- Helping individuals access Apple Health services.
How can I participate?
To participate in the program, you must:
- Be a governmental entity.
- Be contracted with HCA.
- Participate in a time study designed to identify the percent of time you spend performing the Medicaid administrative activities listed above.
Learn more about MAC for public school districts.
School-based health care services
School-based health care services (SBHS) is an optional Apple Health program that provides reimbursement to public schools for certain early intervention health-related services or special education health-related services. This program is fee-for-service and is not covered through managed care.
SBHS reimburses contracted school districts, educational service districts (ESD), charter schools, and Tribal schools for Apple Health covered services provided to students with Title XIX (19) Medicaid (CNP/MNP) coverage and the services are included in the student's current individualized education program (IEP) or individualized family service plan (IFSP).
School-related programs and resources
- School-based health care centers
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School-based health centers (SBHC) are clinics located in or near schools that provide on-site comprehensive and youth-friendly medical, behavioral, and sometimes dental care to students, families, and sometimes the broader community. SBHCs often serve as primary care providers and bill for services similarly to other community clinics.
SBHCs are distinct from Medicaid School-based services (SBS) programs:
- SBHCs: Health care services delivered by community-based providers in a traditional clinical setting located on a school campus.
- SBS programs: School-employed or contracted providers deliver specific health services in the school setting to support a student’s health and educational needs
- School-based Behavioral Health Services and Billing Toolkit
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The Medicaid School-Based Behavioral Health Services and Billing Toolkit provides guidance on how public schools can access Medicaid funding for non-Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) school-based behavioral health services through the Medicaid managed care organizations and fee-for-service programs.
The toolkit also provides behavioral health resources and supports, directions on how to become a behavioral health agency, and best practices for billing Medicaid.
The toolkit is focused on reimbursement for behavioral health services, but public schools may also be able to receive reimbursement for other non-IEP Medicaid-covered services provided in the school setting. Public schools are encouraged to discuss other covered services with MCOs.
- Schools contracting with managed care organizations
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Public schools can contract directly with the Medicaid managed care organizations (MCO) to receive reimbursement for providing Medicaid-covered health services not included in an IEP or IFSP.
Examples of services that public schools may receive reimbursement for include:
- Vision and hearing screenings
- Diabetes and asthma treatment for students with 504 plans
- Behavioral health services
- Immunizations
- Any other non-IEP/IFSP Medicaid-covered health service
Learn more about contracting with managed care organizations.
Division of Behavioral Health and Recovery (DBHR) School-Based Programs
The DBHR School-Based Programs support students' mental health and well-being through comprehensive services and resources delivered within educational settings.
- Project AWARE
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Project AWARE (Advancing Wellness and Resilience in Education) is all about improving mental health support in schools. The project brings together schools, families, and community groups to create a caring and supportive environment for students. By working together, we can help students build resilience, stay well, and reach their full potential. Project AWARE is here to make sure every student has the support they need to succeed.
The Health Care Authority (HCA) is partnering with the Educational Service District (ESD) and district grantees aligns with our Behavioral Health Systems and develop policies that enhance mental health support in schools.
- Federal Match contract
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The Federal Match Grant provides funding to support local projects by matching federal dollars with state or local funds. This grant helps amplify the impact of local initiatives, ensuring that projects have the necessary resources to make a meaningful difference in the community. By combining federal support with local investment, the Federal Match contract enables a collaborative approach to addressing important community needs and enhancing the effectiveness of local programs.
- Mobile Response and Stabilization Services (MRSS)
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Mobile Response and Stabilization Services (MRSS) is designed to meet the unique needs of children, youth, young adults, and their families. In MRSS, the family or young person identifies what constitutes a crisis, and the team responds accordingly. This approach helps keep young people in their homes and communities, reducing trips to the emergency room, avoiding unnecessary involvement with law enforcement, child welfare, or costly out-of-home placements.
MRSS teams provide in-person help, offering crisis de-escalation, risk assessment, and safety planning tailored to each family's needs and strengths. They also work closely with other child-focused systems to improve access to care and reduce barriers. MRSS includes a stabilization phase lasting up to eight weeks, during which the team continues to support the family with skill-building, care coordination, and referrals to additional services. This phase helps prevent future crises and improves long-term outcomes for the youth and their families.
- Kids Mental Health WA
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Kids Mental Health WA supports regions in Washington State in three key areas:
- Establishing community-wide teams to aid children, youth, and families.
- Creating an access portal for individuals to request support for a child or youth.
- Convening multidisciplinary teams from the community to develop stability plans and resource access for children and families.
Health Care Authority (HCA) is partnering with the Behavioral Health Administrative Service Organization, Kid’s Mental Health Pierce County, and the Developmental Disabilities Community Services (DDCS) to implement this program in three regions per year over the next three years.
- The Bridge
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The Bridge is a statewide collaboration between community-based housing providers, behavioral health discharge planners, other community-based professionals, and young people with lived experience. The group aims to increase the number of unaccompanied young people who return to community with safe housing and services upon exiting an inpatient behavioral health setting.
School-based services resources
Federal resources
- CMS Delivering Services in School-based Setting guide
- CMS guide fact sheet
- CMS SBS TAC frequently asked questions
Other resources
(Updated April 2, 2026)