Learn About Medicaid and More: Institutions, Educators, and Students
Since 1988, Medicaid has been helping schools by reimbursing them for essential healthcare services. More than 89 million people in the United States are enrolled in Medicaid, and California has the highest number of enrollees. This funding is significant for schools as it amounts to billions of dollars and ranks as the third-largest funding source for K-12 public schools.
Is Medicaid Required in Schools?
No - schools are not required to participate, nor are they automatically eligible to be part of the state's Medicaid reimbursement program.
In some states, like California, schools can participate in Medicaid reimbursement programs for certain health-related services. Medicaid, called Medi-Cal in California, is a government program that helps low-income families with their medical expenses. When a school district in California decides to participate in the Medicaid reimbursement program, the school becomes a "provider" of health-related services.
Currently, schools can only seek Medicaid funding for medical services provided to students as part of their education plan (IEP), individualized family service plan (IFSP), or Section 504 plan. However, it's essential to know that each state has its own rules regarding how schools can use the Medicaid money they receive. The process for getting reimbursed and the requirements vary from state to state.
If you are a school district interested in Medicaid reimbursement, it's a good idea to check your State's Medicaid Plan and work closely with the Medicaid agency. They can guide you on the specific guidelines, documentation, and billing procedures you must follow.
Generally, schools can receive Medicaid funding for services like:
- Screening and diagnostic services (vision, hearing, mental health)
- Nursing services
- Therapy services (occupational therapy, physical therapy, speech therapy)
- Psychological services
- Social work services
- Assistive technology devices and services
These are just some examples, but other services may also be eligible for reimbursement.
How Does Medicaid Billing Work?
Let's say a student named Sarah receives speech therapy services at her school to help with her communication skills. In collaboration with Sarah's parents, the school district can enroll her in Medi-Cal if she meets specific criteria. Once Sarah is enrolled in Medi-Cal and her parents have agreed, the school can support Sarah with speech therapy services (since these services are eligible for Medicaid reimbursement).
The school district keeps records of the services provided, such as the number of therapy sessions and the duration of each session. The school district then follows the billing and reimbursement procedures of California's State Medicaid Plan. They submit a claim to the state Medicaid agency for the eligible services provided to Sarah. The declaration includes information like the student's Medicaid ID, the services provided, and necessary codes.
Once the claim is received, the state Medicaid agency reviews it and approves the reimbursement to the school district if everything is in order. The reimbursement amount may change based on the services provided and the Medicaid fee in California. This reimbursement helps the school district cover Sarah's speech therapy and service costs. It also allows the school to continue providing healthcare services and support students like Sarah, who require them for educational success.
The Benefits of Medicaid For Students
Let's look at its benefits and how students can feel supported by these services:
- Helps students who can't afford healthcare: Medicaid is a program that ensures students from low-income families can get the medical care they need. It provides health services to these students who may be unable to afford them otherwise. Schools can earn money from Medicaid for health check-ups, tests, and treatments.
- Supports students with disabilities: Sometimes, students with disabilities need special healthcare services to ensure they can learn and attend school. Schools have to provide these services under a law called the Individuals with Disabilities Education Act (IDEA). Medicaid in schools is a way for schools to get money back from Medicaid to help cover the cost of these services.
- Allow schools to hire healthcare staff: Thanks to Medicaid funds, schools can employ healthcare providers such as nurses, psychologists, counselors, therapists, and more. These professionals are a critical factor in supporting students' well-being. When students visit the nurse's office for medical assistance or ask for guidance from a school counselor, they benefit directly from Medicaid's presence in schools. Having these experts available ensures that students receive medical attention, mental health support, and guidance tailored to their needs on time.
So now what?
As a school district, what should your next step to support a student's life be?
As we've seen, Medicaid plays a crucial role in the success of students' education and overall well-being. It helps students access essential healthcare services, therapies, and tools that support their development. By using these resources, students can thrive and actively participate in school. The next step is to include healthcare services within your school to ensure equal student opportunities and break down barriers.
By Denia Villegas
