medicaid funding for school-based services office of special education september 2015
TRANSCRIPT
Medicaid Funding for School-Based Services
Office of Special EducationSeptember 2015
Sec. 4. (a) A public agency may use Medicaid or other public benefits or insurance programs in which a student participates to provide or pay for services required under this article, as permitted under the public benefits or insurance program.
511 IAC 7-33-4
(b) A public agency must provide written notice to the parent: (1) before accessing the student's or the parent's public benefits or public insurance for the first time; (2) prior to obtaining the one-time written parental consent as described in subsection (d); and (3) annually thereafter.
[As used here, public agency means “school district/charter school]
(h) Proceeds from public benefits or insurance or private insurance shall not be considered program income for purposes of 34 CFR 80.25 with respect to the administration of federal grants and cooperative agreements.
(i) If a public agency spends reimbursements from federal funds, such as Medicaid, for services under this article, those funds shall not be considered state or local funds for purposes of maintenance of effort provisions.
511 IAC 7-33-4 Use of public and private insurance
Examples of Covered IEP-Required Related Services
Indiana Medicaid covers the following IEP services:
Audiology
Occupational Therapy
Physical Therapy
Speech-Language Therapy
Mental Health (Psych) Care
Nursing Care Provided by a Licensed, Registered Nurse
Plus:
Medically necessary specialized transportation on a day when the student receives another IEP-required service at school.
Two Different Types of School-Based Medicaid Claiming
1) MAC (MEDICAID ADMINISTRATIVE CLAIMING):pays a portion of schools’ costs for performing ADMINISTRATIVE ACTIVITIES to help students/ families address unmet health needs
2) IEP Direct Services Claiming: pays Medicaid rates for providing covered HEALTH-RELATED SERVICES in the IEP of a Medicaid-eligible Special Education studentIn Indiana, school-based Medicaid claiming is strictly on a voluntary basis. Districts may participate in one, both or neither type(s).
Two Different Medicaid Reimbursement Methodologies
1) MAC (MEDICAID ADMINISTRATIVE CLAIMING): reimburses based on collective results of quarterly statewide random moment time studies documenting activities of all participating districts
2) IEP Direct Services Claiming: reimburses at Medicaid’s rate for each covered “related” service provided per a Medicaid-eligible Special Education student’s IEP
Examples of IndianaMAC-Reimbursable Administrative Activities
Providing information to students and families about Hoosier Healthwise, Medicaid, CHIP and available health care benefitsScheduling, coordinating or referring a student to medical, dental, vision or mental health diagnostic and treatment servicesGathering information that may be required for service referralsDeveloping plans and strategies to improve and eliminate gaps in health service delivery for school-age childrenMeeting with parents or professionals about a child with unmet health care needsCoordinating or attending meetings or trainings related to Medicaid and medical servicesArranging transportation or translation services required for a student/family to access needed health care services
School-Friendly Materials, Accessible to All
Even for those that don’t bill Medicaid
School-Friendly Materials, Accessible to All
Forms & Systems Help Manage Medicaid Claiming Processes & Details
Which Indiana Districts Participate in Medicaid Claiming?
http://www.doe.in.gov/sites/default/files/specialed/school-corp-medicaid-report-sfy15-ytd-12-31-14-final.pdf
Which Indiana Districts Participate in IndianaMAC?
http://www.doe.in.gov/sites/default/files/specialed/school-corp-medicaid-report-sfy15-ytd-12-31-14-final.pdf
Even for those that don’t bill Medicaid
Where Else Can Indiana Schools Find More Information?
www.medicaidforeducation.org
Thank you !
Questions?
Contact:
Tracy Brunner, School-based Medicaid SpecialistOffice of Special EducationIndiana Department of [email protected]