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Medicaid Payment for School-Based Services

Frequently Asked Questions: The School's Role

Why do schools bill Medicaid for speech-language pathology and audiology services provided in schools?

The Federal Medicaid program encourages states to use funds from their Medicaid program to help pay for certain health care services that are delivered in the schools, providing that federal regulations are followed. For many children, schools are the primary point of entry to receiving needed health and social services. Section 1903 (c) of the Social Security Act was amended to allow Medicaid coverage of health-related services provided to children under the Individuals with Disabilities Act (IDEA).

Are schools required to bill Medicaid?

No. School participation in Medicaid reimbursement for certain health related services is one of the optional Medicaid programs available to states. Billing and reimbursement procedures are guided by the State Medicaid Plan. This agreement defines the relationship between the State Medicaid agency and the school district. School districts who choose to participate in Medicaid reimbursement programs are considered the "provider" of the health related services.

See also: I think my school should begin billing Medicaid for eligible children. What do I do?

How do schools use the money they receive from Medicaid?

Each State Medicaid Plan outlines how a district may use Medicaid revenue. Medicaid reimbursement may go to the district's general fund and be used in a variety of ways, which may include:

  • IEP implementation
  • School health services
  • Hiring staff or for salaries for services provided
  • Books, supplies, or other school-related expenses
  • Assistive technology or FM systems
  • Tube feeding expenses

Funds may also be returned to the program that generated the revenue. Some school districts will provide SLPs and audiologists with monies to cover licensing and association fees, professional development/continuing education, technology for staff, or for creation of innovative intervention programs.

See also: How can I get Medicaid funds generated by SLPs or audiologists in my district back into SLP or audiology budget?

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