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Medicaid and School-Based Child Health Services

INFORMATION SHEET

  • 1965: Medicaid program established by U.S. Congress
  • 1988: Catastrophic Medicaid Act allowed for billing in the schools
  • 1997: IDEA recognized ability of school districts to bill Medicaid for certain special education services
  • 2004: IDEA with regulations in 2006 reaffirmed public agencies ability such as school districts to use Medicaid to pay for required services
  • The Center's for Medicare and Medicaid Services (CMS) oversees state Medicaid and State Children's Health Insurance Programs (SCHIP)
  • State Department of Health Services Medicaid Office oversees the State's health programs
  • State Division of Health Care Financing and Policy (DHCFP) oversees Medicaid and Nevada Check up programs to include School-Based Child Health Services
  • Nevada's School-Based Child Health Services covered under Medicaid Service Manual (MSM) Chapter 2800

Background

Medicaid is a "medical assistance program" that recognizes the importance of school-based healthcare (health related) services. Medicaid encourages states to use funds from their program to help pay for certain healthcare services delivered in the schools PROVIDING FEDERAL AND STATE REGULATIONS ARE FOLLOWED. These healthcare services may include psychological counseling, nursing services, physical therapy, occupational therapy, speech therapy, audiology, and durable medical equipment.

Medicaid and IDEA funding cannot overlap; federal IDEA funds only partially cover health related services for students with disabilities in education setting, while Medicaid is primary to IDEA for health-related services.

What & Why

Medicaid and Schools are a combination or partnership between two different groups - public health and public education, coming together for the benefit of children and youth. School Based Child Health Services (SBCHS) are medical services provided through a child's local school district. SBCHS are provided to a Medicaid and Nevada Check Up eligible recipients who meet the Individuals with Disabilities Education Act (IDEA) criteria. SBCHS are reimbursable under the Medicaid program to recipients with special education needs pursuant to an Individual Education Plan (IEP).

The State may or may not require local education agencies (LEAs) or school districts to bill for Medicaid services. If schools do participate, the district enters into an interagency agreement AND a system of billing is established.

Requirements

Who: Service Providers

The providers of the health related services must meet the Medicaid qualification requirements, which may or may not be the same as the requirements to work in the schools.

Certain school-based professionals who do not meet the Medicaid qualification standards may provide services "under the direction of" a qualified Medicaid provider.

What: Documentation

DHCFP requires LEA's to maintain a variety of documents in the IEP. These include but are not limited to:

  • Determination of medical necessity for services;
  • Plans of care;
  • Records of treatment sessions, records of progress notes;
  • Documentation of supervisory activities ("Under the Direction of");
  • Documentation of provider qualifications associated with licensing and certification (Board of Examiners; National Certification)

Contacts

Mr. Jon Kirwan, Nevada Medicaid
        Jon.kirwan@dhcfp.nv.gov; 775.684.3706
Ms. Marva Cleven, Nevada Department of Education
        mcleven@doe.nv.gov; 775.687.9146
Ms. Lori Schwank, Nevada Department of Education
        lschwank@doe.nv.gov; 702.688.4325
Mrs. Nancy Kuhles, M.S. CCC-SLP; NSHA/NV Coalition co-chair; NSHA/ASHA SEAL
        Kuhles119@sbcglobal.net; 775.825.4886

Websites

Centers for Medicare and Medicaid Services: www.cms.hhs.gov
Nevada State Medicaid: www.dhcfp.state.nv.us
National Alliance for Medicaid in Education (NAME): www.medicaidforeducation.org

Resources

American Speech-Language-Hearing Association (ASHA): www.asha.org
Search: "School Funding Advocacy"; "School Medicaid"; "School Medicaid Reimbursement"; "IDEA Medicaid"