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Today’s college students are reporting elevated mental health concerns and a growing expectation for their college or university to provide health and wellness resources to support their thriving while enrolled.

While most colleges are investing some level of financial support into additional mental health services, sustainability remains a concern, particularly as federal COVID-19 relief dollars dwindle.

Community colleges, in particular, can be less resourced to provide wraparound supports but more likely to enroll diverse learners with complex socio-emotional needs.

A new report identifies Medicaid as an underutilized opportunity for community colleges to fund mental and physical health services for low-income students. The study, led by Ryan Stewart, former New Mexico secretary of education, and funded by Kresge and ECMC Foundation, also provides recommendations for colleges, practitioners and state Medicaid agencies.

The background: Medicaid is a federal-state partnership through which the federal government reimburses 50 percent or more of the state’s spending on services provided to qualifying groups, including low-income individuals, pregnant women and children, and those with complex disabilities.

Billing Medicaid for eligible services has been a more common practice in K-12 schools for decades, with many districts providing services such as speech therapy, occupational therapy or mental health services to learners. Costs get reimbursed when delivered by a licensed provider to students enrolled in Medicaid.

Institutions of higher education, conversely, have been left out of the process, with only California explicitly including colleges in Medicaid administrative procedures similar to public K-12 schools.

Methodology: Researchers conducted a search of the National Provider Identification database, which is run by the Center for Medicare and Medicaid Services, to identify community colleges listed in the database to request how much Medicaid reimbursement they received between 2018 and 2023. The report authors also contacted state Medicaid agencies directly to identify reimbursements for community colleges. In total, the study includes data from 1,017 colleges across the U.S.

The report also includes revenue potential offered by Medicaid, which was calculated through the health services currently offered at the institution, the estimated number of Medicaid-eligible (or Pell-eligible) students enrolled, estimated numbers of students receiving each category of services and the average reimbursement per student based on state data.

Researchers also surveyed administrators of community colleges evaluated in the study about their health services to identify services available and other leadership priorities.

The findings: Of the 1,017 colleges reviewed, 855 offered some form of health services, a majority of which were related to mental or behavioral health only. Only 16 percent of institutions provided no health services, and 2 percent provided only physical health resources.

Among survey respondents, just 3 percent identified their institution as having strong financial resources to offer an extensive array of affordable health resources. The greatest share (33 percent) identified as precarious, or able to offer a limited number of services, and financial pressures could require service cuts in the near future. Thirty percent of respondents indicated they had insufficient resources, and another 30 percent indicated their resources were sufficient.

However, only 32 community colleges have received any amount of Medicaid reimbursement for services since 2018. Twenty-nine of these institutions are in California, and the other three in Delaware, Idaho and New York.

Fifty community colleges in nine states had an active National Provider Identification number, signaling they previously registered to bill Medicaid for services.

“The paucity of Medicaid participation among community colleges nationwide results in over $115 million being left on the table each year by institutions that often find themselves in dire need of resources to support their students’ health and well-being,” according to the report.

Around $52 million of these dollars would come from mental and behavioral health services; $20 million from first aid, immunizations, health assessments and diagnostics; and $8.5 million from sexual and reproductive health or family planning services all currently offered at the institutions.

Why not? When asked why administrators do not currently claim Medicaid reimbursements for eligible services, nearly half (45 percent) of community college leaders indicated they were not aware of the option. A lack of capacity to engage the Medicaid billing process (38 percent) and navigating the complex system (21 percent) were the other top reasons.

Three percent of college leaders said they were interested in billing Medicaid but just haven’t done it yet.

Some state policies created challenges for community colleges to enroll in Medicaid, such as limitations on the ability to claim direct services, service or staffing requirements, or contracting requirements. This was the case for 11 states, leaving the majority of communities able to enroll without significant restrictions, according to the report.

So what? To overcome this gap of underutilized funds, researchers recommend community college leaders partner with the state Medicaid agencies to review their eligibility for participation, analyze revenue potential and request technical assistance with implementation.

Colleges should also set goals for the number of students who participate and for reimbursement revenue generated.

Researchers also see opportunities for higher education practitioners to get involved in this work through championing Medicaid participation.

“Student success advocates who have the ability to gain an audience with community college administrators—or the people who influence college administrators—should work with the administrators to encourage colleges to participate in Medicaid, if they do not already,” according to the report.

State agencies could also convene communities of practice for community colleges who participate in Medicaid for collective learning and problem-solving work.

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