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Medicaid and Education. April 13, 2011. 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.

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Medicaid and education

Medicaid and Education

April 13, 2011

State plan
State Plan

Each state determines its State Plan within the general guidelines of the federal CMS.

Medicaid and education timeline
Medicaid and Education Timeline




Medicaid State Plan Amended


U.S. Congress

WV Code 18-2-5b

…for children with IEPs


IEPs, Care Coor, Sp. Trans. Personal Aides

Only Therapies

Wv code 18 2 5b
WV Code 18-2-5b

(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…

Medicaid and education

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.

Medicaid and education

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)]

Medicaid and education

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.

Medicaid and education

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)

Medicaid and education



Each School District – 1st #

Therapy Provider # 0 00XXXXXXXX

Audiology #

OT #

PT #


RN #

Psychology #

Each School District – 2nd #

Cost-Based Provider #


Initial/Triennial IEP

Annual IEP

Personal Care (full)

Personal Care (part)

Sp. Trans. Vehicle

Sp. Trans. Aide

Care Coordination

Medicaid and education

Billing Form or WVEIS Entry





Bureau of








Remittance Advice


Payment – Direct Deposit

Supporting Documentation:


Progress Notes

Attendance Records

Care Coordination form


  • Student Related Documentation

    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

  • Billing Documentation - WVEIS

Maintain documentation in the student’s individual cumulative file in a centralized location.

Freedom of choice
Freedom of Choice

Freedom to choose services from providers

outside the school system



isnottoseekreimbursement for services

that are provided by an outside agency.

(Consent form)

Frequently asked questions
Frequently Asked Questions

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)

Frequently asked questions1
Frequently Asked Questions

Care Coordination : Coordinate delivery of services

related to IEP.

Check all activities completed

during that month, but may

bill even if only one activity

was checked.

1 billing per month/per student = $77.09/mo.

Medicaid and education

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).

Medicaid and education

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.