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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
Medicaid for some mental health services provided to eligible students in special education as well as through school-based health centers. However, these centers can bill Medicaid for these services only if they are provided by enrolled Medicaid providers. Enrollment is not often supported by the administrative capacity of many of these centers, and available providers may not be eligible. In addition, a very small percentage of schools have school-based health centers. Most provide health services directly by school employees (e.g., nurses, psychologists) who can receive only limited Medicaid reimbursement through agreements that vary from state to state (Kautz, Mauch, and Smith, 2008). And 20 percent of public schools report Medicaid reimbursement as a funding source for preventive mental health services (Foster, Rollefson, et al., 2005).
Addressing these obstacles to adequate reimbursement from both private and public payers is one necessary step toward improving preventive services for MEB disorders in primary care and at the interface between primary care and the school system, two of the major entry points for children and families in need of these services.
Some of the identified barriers to reimbursement are amplified by misunderstanding or misinterpretation of covered services and reimbursement rules and could be addressed through clarification of and education about reimbursement policies and definitions, especially in cases in which interpretations at the state and local level may be narrower than federal law (Kautz, Mauch, and Smith, 2008). Some states have also taken advantage of both improved clarity and flexibility in designing Medicaid benefits using Medicaid waivers to achieve improved coverage for mental health services; these can serve as models for change in other states. Other reimbursement barriers would require an expansion of allowable coverage by both publicly and privately funded insurance to increase reimbursement for mental health services that include prevention and screening (Kautz, Mauch, and Smith, 2008; Nitzkin and Smith, 2004).
SYSTEMS THAT SUPPORT DELIVERY OF PREVENTIVE SERVICES
In addition to the provision of funding, federal, state, and local governments can support service delivery systems that provide preventive services by identifying effective interventions as well as by offering technical assistance to community coalitions or organizations.
Identifying Effective Interventions
Federal agencies have sponsored multiple efforts to assess the evidence available related to specific preventive intervention programs. Four federal programs that have analyzed information about preventive interventions