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What is the Medicaid School-Based Services Program?

State and federal regulations allow school districts (LEA) to seek partial reimbursement for medically related services that are listed on a student’s Individual Education Plan (IEP). Although this partial reimbursement is available only for students who are Medicaid eligible, services are provided to all students with disabilities regardless of their Medicaid eligibility status.

What type of services does the School-Based Program cover for children?

  • Behavior Services
  • Nursing Services
  • Personal Health Services
  • Transportation
  • Escort services during Transportation

Why does the district seek federal Medicaid reimbursement funds?

Medicaid reimbursements are applied for to offset the expense of special health related services that generally exceed budget allocations and state appropriations. Without Medicaid reimbursements it would be difficult to fund those services.

What are the requirements needed to bill for services?

  • Students must be in special education
  • Students must be currently eligible for Medicaid
  • Students must have a medical diagnosis
  • Services to be billed must be related to the student’s diagnoses
  • Services to be billed must be described in the student’s IHP or BIP and linked to the IEP

Why is parental consent needed?

A Medicaid claim is considered an “educational record”. In accordance with the Family Education Rights and Privacy Act (FERPA) such records cannot be disclosed to a third party (Medicaid) without the prior written approval of a parent or guardian. This is the reason parental consent is sought before a claim is submitted.

Need more information?

For more information about School-based Medicaid reimbursement, please contact.

Christine Boline

Special Services – Medicaid