Coalition for Healthy Students - New York State (CHS-NYS)

What is School-based Medicaid Expansion?

In 2014, the Centers for Medicare & Medicaid Services (CMS) issued a state Medicaid director letter announcing a policy change impacting school-based Medicaid programs. Sometimes known as the Free Care Rule reversal, this policy change would allow school districts to bill Medicaid for health services delivered to ALL Medicaid-enrolled students, not just those with special health needs documented in an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP). To date, 25 states have expanded the ability of school districts to bill Medicaid for health services delivered to all Medicaid-enrolled children, with broad support from CMS.

Recent Progress

Although legislation is not required to enact school-based Medicaid expansion, CHS-NYS worked with the NYS Legislature to introduce bills (A9475/S8639) with Assemblymember Karines Reyes and Senator Samra Brouk in 2022-2023. This legislation directed the New York State Department of Health (NYS DOH) to pursue a state plan amendment (SPA) to expand school-based Medicaid. The bills received broad support and were reintroduced in the 2023-2024 session (A4408/S1875).

On September 29, 2023, NYS DOH submitted SPA language to CMS requesting that schools in NYS be reimbursed for behavioral health services provided to ALL Medicaid-enrolled students. While CHS-NYS sees this as a great first step, we continue to advocate for a more comprehensive SPA that covers all medically-necessary Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, and not just behavioral health alone.

Who We Are


The Coalition for Healthy Students – New York State (CHS-NYS) was founded by Children’s Health Fund in early 2020. CHS-NYS is a group of several child welfare organizations that raise awareness and support for school-based Medicaid expansion in New York State. Support for this critical policy change began gaining momentum in NYS in 2021. In 2021, CHS-NYS joined forces with our legislative champion, Assemblymember Karines Reyes, to gather signatures from 50+ legislators on a letter urging NYS DOH to ​submit a school-based Medicaid expansion SPA to CMS.

CHS-NYS also led a working group in 2021 to work toward expanding school-based Medicaid programs. Our working group included representation from NYS DOH, the New York State Education Department (SED), and the Big 5 Conference, including three of the largest school districts in New York State. As a result of progress made during the working group, the Medicaid Unit of NYS DOH agreed to recommend to their executive leadership that a SPA expanding EPSDT services to all Medicaid-enrolled students in NYS be included in the FY22 executive budget. 

Our Membership

Children’s Health Fund (lead convener)

Children's Defense Fund - New York

Citizens’ Committee for Children of New York

Families Together in New York State

New York State School Boards Association

PM Pediatrics

Schuyler Center for Analysis and Advocacy

The Children’s Agenda

United Community Schools - United Federation of Teachers

NYS school district partners:

New York City Public Schools, Rochester City School District, Yonkers City School District

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