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Medicaid is a jointly federal-state program that provides health coverage to eligible beneficiaries.

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.

Services that are commonly found on an IEP/IFSP and are part of a state plan may include: audiology, nursing, speech-language services, occupational therapy, physical therapy, personal care, mental health and behavioral health services, and specialized transportation. Services that are eligible for reimbursement vary from state to state.

Originally, the free care rule forbade schools from charging Medicaid for services that were free to all students, even if Medicaid would cover those services. Only those services provided to special education students were eligible for reimbursement. A December 2014 letter from the U.S.

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.

Many states are currently writing or have submitted State Plan Amendments (SPAs) to the Centers for Medicaid and Medicaid Services (CMS). For example, Louisiana and Massachusetts have received approval, while California and Georgia have amendments pending.

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.

The Centers for Medicare and Medicaid Services (CMS) provides audit guidance identifying the documentation that is required during a federal audit. Each state may require additional documentation for audits over and above the federal requirements.

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.

No. Under the Affordable Care Act (ACA), there are no lifetime benefit maximums. Additionally, eligible individuals’ participation in the school-based Medicaid program will not decrease available lifetime coverage or any other insured public benefit and will not increase premiums or lead to discontinuation of public benefits or public insurance.

Under the Affordable Care Act, states are beginning to implement the requirement for all service claim types to include the referring provider credentials with a claim. The definition of this person can vary from state to state. In some circumstances it is an actual physician that approves services identified in an IEP. In other states, the licensed provider, such as a Speech Pathologist or Occupational Therapist, are allowed to be the referring providers. Not all states have implemented this rule, so please refer to your state’s guidebook and companion guides for specific guidance.