Medicaid and Education. April 13, 2011. www.cms.gov. State Plan. Each state determines its State Plan within the general guidelines of the federal CMS. Medicaid and Education Timeline. 1989. 1990. 2000. Medicaid State Plan Amended. IDEA. U.S. Congress. WV Code 18-2-5b.
Medicaid and Education
April 13, 2011
Each state determines its State Plan within the general guidelines of the federal CMS.
Medicaid State Plan Amended
WV Code 18-2-5b
…for children with IEPs
IEPs, Care Coor, Sp. Trans. Personal Aides
(a) The state board shall become a Medicaid provider and seek out Medicaid eligible students for the purpose of providing Medicaid and related services to students eligible under the Medicaid program and to maximize federal reimbursement for all services available under the Omnibus Budget Reconciliation Act of one thousand nine hundred eighty-nine, as it relates to Medicaid expansion…
A noneducational public agency described in paragraph (b)(1)(i) of this section may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context…
Reinforced that Medicaid would reimburse covered services provided by the school.
A public agency may use the Medicaid or other public benefits or insurance programs in which a child participates to provide or pay for services required under this part, as permitted under the public benefits or insurance program…[300.154(b)]
If a public agency spends reimbursements from Federal funds (e.g., Medicaid) for services under this part, those funds will not be considered "State or local" funds for purposes of the maintenance of effort provisions in Sec. Sec. 300.163 and 300.203.
Reduction of Other Benefits.--Nothing in this part shall be construed to permit the State to reduce medical or other assistance available or to alter eligibility under titles V and XIX of the Social Security Act…(300.186)
Each School District – 1st #
Therapy Provider # 0 00XXXXXXXX
Each School District – 2nd #
Cost-Based Provider #
15XXXXXXXX - New
Personal Care (full)
Personal Care (part)
Sp. Trans. Vehicle
Sp. Trans. Aide
Billing Form or WVEIS Entry
Payment – Direct Deposit
Care Coordination form
Included in IEP services – the IEP form
Therapy notes/log: Notes/outcome re: student
progress and prognosis
The Care Coordination form
Personal Care form
Specialized Transportation form – number of special education students riding specialized transportation
Maintain documentation in the student’s individual cumulative file in a centralized location.
Freedom to choose services from providers
outside the school system
isnottoseekreimbursement for services
that are provided by an outside agency.
Personal care : Services must be provided
on a full-time basis. The
aide must not be
responsible for any other
Not specific to the aide
Full-time / Full Day = $150.94/day ($3,018.80/month – 20 days)
Full-time/ Partial Day = $75.47/day ($1509.40/month – 20 days)
Care Coordination : Coordinate delivery of services
related to IEP.
Check all activities completed
during that month, but may
bill even if only one activity
1 billing per month/per student = $77.09/mo.
Discussion: In order for a public agency to use the Medicaid or other public benefits or insurance program in which a child participates to provide or pay for services required under the Act, the public agency must provide the benefits or insurance program with information from the child's education records (e.g., services provided, length of the services).
Information from a child's education records is protected under the Family Educational Rights and Privacy Act of 1974, (FERPA)… Under FERPA and section 617(c) of the Act, a child's education records cannot be released to a State Medicaid agency without parental consent, except for a few specified exceptions that do not include the release of education records for insurance billing purposes.