Frequently Asked Questions
How can public schools utilize Medicaid to help recover costs associated with delivering health related services?
Public schools in most states are eligible to apply to be a Medicaid provider of both direct health related services and administrative claiming activities which include enrolling eligible children in the Medicaid program and assisting families to access benefits available to them.
This allows schools to recover a portion of the costs they incur when providing health related services to students who are eligible for Medicaid and the costs associated for Medicaid outreach activities.
What Services are Medicaid reimbursable for schools?
Are Medicaid School-based reimbursements limited to special education students?
Department of Health and Human Services made clear that states can charge for services delivered to students receiving Medicaid as long as they are covered by the state plan and delivered by a qualified provider.
This allows reimbursement for students with a 504 plan or Non IEP/IFSP services that meet a states specification to now be claimed.
What is a SPA and is your state developing a SPA?
Louisiana has moved forward with implementation, expanding on a 2011 change that authorized school nurses to deliver Medicaid services to students with Individualized Education Plans (IEPs).
Massachusetts is developing guidance for how local school districts should seek reimbursement and track the time spent on providing services. Schools will be able to seek reimbursement for a set of services expanded to include, nutritional, respiratory, optometry, physician and some dental. To look up information on your state click on this link, https://www.medicaid.gov/state-resource-center/medicaid-state-plan-amendments.
What are some of the documentation required to be prepared in an audit if you are participating in the Medicaid program?
A list of specific services that have been claimed for reimbursement will require the following documentation: Student’s Medicaid ID number, Provider’s Medicaid number or their National Provider Identifier number (NPI), date the service was provided, type and duration of the service, copy of the students IEP, IFSP, or health care plan, proof of necessary provider licensure/certification, Attendance records of both the student and the provider.
Can billing Medicaid for school-related services affect the parent’s lifetime benefits or maximums?
What are Ordering, Referring or Prescribing providers?
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