Medicaid School-Based Services

The Federal Medicaid program recognizes the importance of school-based health services in the delivery of essential medical care to eligible children, and allows states to use their Medicaid programs to help pay for certain health services delivered to children in the school setting. School-based services are health-related and rehabilitative services provided to children with disabilities who receive services under the Individuals with Disabilities Education Act (IDEA). Schools can submit claims to Medicaid for reimbursement for certain services provided by qualified school employees, contracted employees or contracted agencies. Although the federal requirements for the Medicaid program apply in all states, Medicaid is administered jointly by the federal and state governments and each state has its own unique rules.

Warrensburg Central School District is eligible to receive reimbursement for school-based services provided that:

  • The child is eligible for Medicaid
  • Each service is specifically identified on an Individualized Education Program (IEP)
  • Services are medically necessary for a child to benefit from their educational program

Services are determined by the CSE/CPSE committee and must be referred by a physician or practitioner of the healing arts to determine that the services are medically necessary for Medicaid reimbursement. Parents/guardians are notified that the District intends to bill Medicaid for the child’s services, and parents have the opportunity to sign a release form to have the school bill Medicaid directly for services rendered.

The following services are eligible for Medicaid Reimbursement with the proper documentation:

  • Behavioral Intervention
  • Behavioral Consultation
  • Evaluations
  • Medical Equipment and Supplies
  • Nursing Services
  • Speech/Audiological Therapy and Evaluation
  • Occupational Therapy and Evaluation
  • Physical Therapy and Evaluation
  • Transportation Services
  • Interpretive Services
  • Psychotherapy
  • Psychological Evaluation
  • Personal Care Service

If schools do not wish to receive Medicaid reimbursement, they are still required to provide those services mandated by the IDEA. If a child loses Medicaid, the services that they receive through their IEP should not be affected. Mrs. Stephanie Gibson is the Medicaid Coordinator for the District and can be reached at 518-623-9747 x2.

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