Due to an unexpected federal policy reversal sought by advocates for nearly 10 years, schools could start billing Medicaid for health services such as asthma screenings, vaccinations and care for chronic diseases provided to some low-income students.

According to a 1997 rule by the Centers for Medicare and Medicaid Services (CMS), known as the “free care rule,” if schools provided a service to the public for free, the schools couldn’t ask Medicaid to pay for that service when provided to a Medicaid-eligible student – even if Medicaid would pay for the service if provided in a medical setting. Exceptions were allowed for some children with disabilities.

Last December, CMS finally reversed the “free care rule” in a State Medicaid Directors Letter aiming to help remove “any ambiguity” about the policy.