Medicaid Reimbursement

  • Medicaid is a jointly funded Federal-State health insurance program for persons with low income and/or disabilities. The School Based Services program allows districts to receive reimbursement for services provided to students with special needs under the Individuals with Disabilities Education Act (IDEA).

     

    The School Based Services program is divided into two very distinct segments:

    • The Fee for Service Program receives partial reimbursement for direct medical services provided to special education students through the age of 21.  (see below for more information)

    • The Administrative Outreach Program receives partial reimbursement for the administrative costs to identify and help students who are considered "at risk" for various health problems.  (see below for more information)

     

  • Medicaid Fee for Service Overview

    This portion of the program obtains reimbursement for districts to provide direct health-related services and for case management services for special education students who are eligible for Medicaid.

    The personnel in the local districts who service these students are as follows:

    • Audiologists - licensed

    • Certified Occupational Therapy Assistants

    • Early Identification/Intervention Personnel

    • RNs and LPNs

    • Occupational Therapists

    • Orientation and Mobility Specialists

    • Licensed Physical Therapists 

    • Physical Therapy Assistants

    • Psychiatrists

    • Psychologists

    • Social Workers

    • Special Education Classroom Teachers

    • Teacher Consultants

    • Speech Pathologists

    • Personal Care Paraprofessionals

    The above school staff members provide a wide range of health services to their students.  Special education teachers provide case management services by ensuring that the student's plan of care is followed.  Staff members log their services monthly for reimbursement.  

    Illuminate Documentation Website

  • Medicaid Administrative Outreach Program

     The Administrative Outreach Program receives partial reimbursement for the administrative costs to identify and help students who are considered "at risk" for various health problems. The goal is to direct these students and their families to the proper resources for help.

    This program generates revenue by tracking the time spent on Outreach activities by school personnel and by factoring the district's expense for staff providing these services.

    School personnel chosen in the random moment sample are expected to complete their time study. Failure to do so affects the administrative portion of the state-wide reimbursement. 

    The following school personnel participate in the Outreach portion of the School Based Services program:

    • Audiologists

    • Speech Pathologists

    • Social Workers

    • Occupational Therapists

    • Certified Occupational Therapy Assistants

    • Physical Therapists

    • Physical Therapy Assistants

    • RNs and LPNs

    • Psychologists

    • Psychiatrists

    • Orientation and Mobility Specialists

    • Teacher Consultants

    • Counselors

    • Early Identification/Intervention Personnel

    • Hearing Impaired Interpreters

    • Special Education Program Administrators

    • Program Specialists

Medicaid School Based Services Quality Assurance Plan

If you are having trouble viewing the document, you may download the document.