Schools can bill Medicaid for health-related services when those services are provided to children and adolescents who are enrolled in the Medicaid program, or when the services are offered through an Individualized Education Plan (IEP). These plans are covered under the Individuals with Disabilities Education Act, and schools can bill Medicaid for outreach and enrollment activities which may be necessary under school administration policies. This represents a significant amount of money, generally in the neighborhood of $6 billion annually, so this is a very large and comprehensive program in the schools of this country.

School-based services

There are two very important reasons why schools provide a good setting for health services to be delivered to children who have Medicaid coverage. Firstly, schools are one of the most convenient and accessible venues for health-related services, because children are actually in attendance for several hours every day. This is true for more than half the days in any given year, so it’s a very convenient way of providing any necessary health services.

Secondly, public schools are required to provide children with disabilities an appropriate free public education. This includes any related services which might be necessary, for instance physical therapy or speech therapy, which will help a given child to learn. Most services which are provided to schoolchildren are covered by Medicaid, generally under that state’s formal Medicaid program. Schools can also bill Medicaid for various administrative activities, provided that the school meets federal and state requirements for Medicaid providers.

Since the year 1988, schools have been able to bill Medicaid for health and related services which are mandatory under IDEA, if those services are provided to disabled children who are eligible for Medicaid. Under the IDEA program, disabled children are eligible to receive any kind of educational or related service which will help them accomplish educational objectives, as outlined in their IEP. The IEP will always be a written plan for an individual student which has been developed by the school’s IEP team, and which has been customized to the specific needs a student might have. 

Evaluations

Schools can also bill Medicaid for evaluations that will discover any health-related needs that a student might have. It will be necessary for this assessment to be conducted by a certified Medicaid provider, and this would be determined by collaborating with a local Medicaid outlet. All health-related services provided subsequently would be subject to state specifications on the scope, duration, and amount of any covered services. The services must also be deemed to be medically necessary, and if all these requirements are in place, Medicaid would be the primary payer for such services, and could be billed for them by any school.

Administrative services

Schools have the capability of billing Medicaid for funding certain school-based administrative activities considered to be appropriate for the proper administration of the state plan for Medicaid services. These administrative activities will generally fall into two distinct categories, the first of which would be outreach and enrollment, and the second being all those efforts which support the delivery of Medicaid services.

Schools can bill Medicaid for outreach for eligible children and families, as well as for making enrollment determinations, provided that the state Medicaid agency has delegated this function to the school. Schools can also bill Medicaid for activities which facilitate students’ access to care coordination, referrals, and transportation back and forth from school, on those days where a student receives services covered by Medicaid.

Services delivered by school-based health centers

School-based health centers (SBHC’s) provide a considerable number of health services to students such as preventive care, behavioral healthcare, oral healthcare, and diagnostic care. In some cases, schools may also provide acute care services, for instance asthma treatment. While some schools actually employ health professionals for the purpose of providing these types of services, other schools set up school-based health centers to provide the necessary services.

As long as the health center has been enrolled as a state Medicaid provider, these SBHC’s can bill Medicaid for all state plan services offered to children who are enrolled in Medicaid. In systems which have managed care, SBHC’s will often contract with managed care organizations, so as to become part of their provider network. Every year, close to 90% of school-based health centers will bill state Medicaid agencies for the services provided during that school year.

Ensure your school district is maximizing resources by maximizing your State’s Medicaid reimbursement.

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