Medicaid & Schools
Introduction
Virginia's public schools provide health related services to students. Through the Medicaid school-based services program, the Department of Medical Assistance Services (DMAS) can reimburse school divisions for some costs associated with providing these services to children enrolled in Medicaid or FAMIS.
Local educational agencies (LEAs) may seek partial reimbursement from the DMAS for eligible health services provided by Medicaid-qualified providers to Medicaid-enrolled students. The DMAS also provides partial reimbursement for health-related administrative activities.
Medicaid Reimbursable Direct Services
- Physical Therapy
- Occupational Therapy
- Speech Language Pathology
- Audiology
- Mental/Behavioral Health
- Nursing Services
- Medical Evaluations
- Personal Care Services
- Applied Behavioral Therapy
- EPSDT Physicals
- Specialized Transportation (Transportation Services must be in an IEP)
Evaluations for these services are also covered services and must meet the DMAS requirements to seek partial reimbursement.
Effective July 1, 2022, the Medicaid State Plan Amendment (SPA) removed the requirement of the service being listed in the IEP. The SPA also expanded services to include:
- Expanded current billable services outside of special education (with the exception of transportation)
- Expanded Behavioral/Mental Health Providers to include VDOE Licensed Psychologist and School Counselors
- Added Applied Behavioral Therapy as a direct reimbursable service.
- Adding Public Health as an administrative activity
- Moved Transportation out of the annual cost report by settling the cost quarterly without claims submission and expanding the definition to include adapted cars and other specially adapted vehicles
- Expand services to include some crisis care and screening
Medicaid Administrative Claiming
Participating school division can receive partial reimbursement for covered health-related administrative activities (indirect services) for access to health care services. These health-related activities include:
- Medicaid outreach & application assistance
- Specialized transportation scheduling/arranging
- Translation services related to health care service delivery
- Program planning and policy development related to the delivery of health services
- Referral, coordination and monitoring of health services
Resources
- Family Education Rights and Privacy Act (FERPA) regarding releasing educational information - Joint information on HIPAA and FERPA
- Special Education regulation regarding accessing a student public insurance
- Information on Medicaid Enrollment/Re-enrollment
- Role of a Medicaid Coordinator
- The Department of Medical Assistance Services (DMAS) School Based Services webpage includes guidance documents, provider manuals, information for Medicaid coordinators training materials, and more.
- National Alliance for Medicaid in Education