In support of President Biden’s effort to address the nation’s mental health crisis, HHS issues guidance to states on ways to expand mental health care for children, and proposes requirements for states to report certain health care quality measures for children and adults.

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced three key actions to strengthen and expand access to high-quality, comprehensive health care for children across the country. These actions are part of HHS’ ongoing efforts to support President Joe Biden’s call to address the nation’s mental health crisis, including its impact on children.

HHS issued a new guidance document reminding states of their mandate to cover behavioral health services for children in Medicaid, and urged states to leverage every resource to strengthen mental health care for children. HHS is issuing a second guidance document that urges states to expand school-based health care for children, including mental health care. As part of the third action, HHS issued a proposed rule that, for the first time ever, would require states to report certain quality measures to strengthen Medicaid and the Children’s Health Insurance Program (CHIP) to ensure that the millions of children and families enrolled in these programs have access to the highest quality of care.

The two guidance documents and the proposed rule follow two recent Biden-Harris Administration efforts to address the youth mental health crisis by strengthening mental health services for children. In July, HHS Secretary Xavier Becerra and Education Secretary Miguel Cardona sent a letter to governors calling on them to invest more in mental health services for students. In March, Secretary Becerra and Secretary Cardona launched a joint-department effort to expand school-based health services, ensuring children have access to the health services and supports necessary to build resilience and promote wellbeing. The joint-department efforts are a direct action stemming from President Biden’s call following the State of the Union to develop guidance to schools that will help them leverage Medicaid to provide mental health support for students in our school.

“As we begin the school year, a top priority of the Biden Administration is to ensure all children have access to the full range of care and support they need to stay healthy and thrive – including mental health services,” said HHS Secretary Becerra, who has been traveling across the country as part of the HHS National Tour to Strengthen Mental Health. “For the millions of children who are covered by Medicaid and CHIP, this means working with states to ensure they are pulling every lever to strengthen and expand comprehensive access to mental health care for children.”

The nation is facing an unprecedented mental health crisis, particularly among children. Even before the pandemic, rates of depression, anxiety and suicidal thoughts were on the rise, with up to one in five children ages 3 to 17 in the U.S. having a mental, emotional, developmental, or behavioral disorder. The pandemic only exacerbated these issues, with increased isolation and disrupted learning, relationships, and routines. More than 40 percent of high school students struggle with persistent feelings of sadness or hopelessness, and more than half of parents and caregivers are concerned about the mental well-being of their children.

“Children’s use of health services – from primary and preventive care to childhood vaccinations, dental care, and mental health services – has dropped alarmingly during the COVID-19 public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “We need to reverse that trend now and expand access to care for eligible children and families. State partners and schools are key to helping children of all backgrounds learn, grow, and thrive.”

Medicaid and CHIP are a lifeline for families across the country. Together, they provide 51% of our nation’s children and youth – more than 40 million children – access to quality, affordable health care. For children who are covered by Medicaid and CHIP, HHS’s actions today will strengthen and expand health care services for them as they head back to school. Details about these actions are below. 

• An informational bulletin from CMS: “Leveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth.” In this guidance document to states, CMS is reinforcing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) statutory mandates for children’s health coverage, in particular mental health coverage. The EPSDT benefit is a requirement for all states and provides comprehensive and preventive health care services, including mental health services, for most children under age 21 who are enrolled in Medicaid. CMS is urging state agencies and stakeholders to use every possible tool offered by Medicaid and CHIP, alone or in tandem with funding from other federal programs, to provide high-quality behavioral health services to eligible children and youth. The guidance includes strategies to improve prevention, early identification, and treatment; expand provider capacity; and increase the integration of behavioral health and primary care. This guidance represents one of many steps CMS will take to strengthen behavioral health services for children in the Medicaid program.

• An informational bulletin from CMS: “School-based Health Services in Medicaid: Funding, Documentation, and Expanding Services.” In this guidance document to states, CMS is prompting states to work with schools to deliver on-site health care services to children enrolled in the Medicaid program – covering nine essential policy areas related to benefits and payment. Providing essential health care in schools, including mental health services, better positions providers to reach children and youth where they are to get them the care they need. Medicaid covers many services that may be provided through schools, including immunizations, health screenings, oral health care, substance use disorder treatment, and mental health care. This guidance represents one of several steps CMS is taking to support access to Medicaid school-based health services – including actions it will take to implement provisions of the Bipartisan Safer Communities Act – and to promote the availability of Medicaid-covered services, including mental health treatment, in schools.

• The Mandatory Medicaid and CHIP Core Set Reporting proposed rule. This proposed rule, which includes a Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP, details proposed mandatory reporting requirements that would standardize quality measures across Medicaid and CHIP for children nationally – helping to promote health equity, and strengthen the quality of Medicaid and CHIP services across the country. The Child and Adult Core Sets include a range of measures key to determining how well Medicaid and CHIP meet their mission of providing affordable, high-quality, person-centered health care coverage to low-income people, including children and families. The proposed rule will mandate reporting of the Core Set for children, and behavioral health quality measures for adults. In doing so, the Core Set can help CMS and stakeholders evaluate Medicaid and CHIP across the 54 programs run by states and territories. Specifically, the mandatory Core Sets would evaluate how Medicaid and CHIP coverage is meeting the needs of individuals and communities, including where health disparities persist, and how the quality of care can be improved. This proposed rule would also mandate national reporting of behavioral health metrics for adults, and details quality metrics for the Medicaid “health home” model.

Read CMS’ guidance: “Leveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth” informational bulletin on Medicaid.gov.

Read CMS’ guidance: “School-based Health Services in Medicaid: Funding, Documentation, and Expanding Services” informational bulletin on Medicaid.gov.

To learn more about the proposed rule for mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP, the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid, and the Core Sets of Health Home Quality Measures for Medicaid, please visit the Federal Register.

About HHS’ National Tour to Strengthen Mental Health

Following the President’s State of the Union in March, Secretary Becerra kicked off the HHS National Tour to Strengthen Mental Health to address the behavioral health challenges –including substance use, youth mental health, and suicide – that have been exacerbated by the COVID-19 pandemic and gun violence in our schools and communities. Since kicking off the tour, Secretary Becerra and HHS leaders have been traveling across the country to hear directly from Americans about the mental health challenges they are facing and engage with local leaders to strengthen the mental health and crisis care system in our communities.