Your path to maximizing Medicaid reimbursements and compliance
School-based Medicaid claiming is an ongoing process used to help schools recover a portion of the costs associated with providing healthcare and support services to eligible, Medicaid-enrolled students. This is one small part of the State/Federal Medicaid program which provides health insurance to low-income families.
An individualized education plan (IEP) outlines the services, modifications, and
accommodations needed to support a student who is eligible for special education services. This eligibility may be due to cognitive or developmental delays, ADHD, hearing, vision or speech impairment, etc.
Prior to 2014, school districts could only seek Medicaid reimbursement for eligible services provided to Medicaid-enrolled students with IEPs. State-by-State that guidance has begun to change.
Submitting Medicaid claims for Students without IEPs
In 2014, the Federal Government’s Centers for Medicare and Medicaid Services (CMS) outlined a ruling that reversed the free care rule. This is often referred to as the “free care policy reversal.” While some States are still working to get the infrastructure in place to support this reversal, many others have already begun accepting eligible Medicaid claims for Medicaid-enrolled students without an IEP. Check with your State or contact our team to learn how this applies to your district.
A research initiative by the Campaign for Educational Equity shows that healthier students are better learners. If your district is already providing the health-related services required to help close the achievement gap, taking advantage of school-based Medicaid claiming can help you recover some of the costs associated with those programs.
School districts across the United States receive a total of about $4.5 billion in Medicaid reimbursements each year.
One in every
Behind Title I of NCLB
and IDEA, Medicaid is
the third largest
source of funding for
The old saying goes something like “change is the only constant in life.” Well, in school-based Medicaid claiming, it’s no different. Advances in technology, changes to State and Federal legislation, and macro-environmental factors like the recent COVID-19 pandemic all lead to major shifts and sometimes great
opportunities in the services we provide students and how we approach reimbursement for them. Here are a few of the more recent trends impacting school-based Medicaid claiming:
Nursing & Physical Health
These are just some examples of the billable services your district may provide. And remember, when it comes to Medicaid billing in schools, often both the evaluations and the treatment are reimbursable. When in doubt, don’t miss out. Ask!
What’s Billable in my State?
From State-to-State, the services you can bill for as part of your school-based
Medicaid claiming program can vary. While the Centers for Medicare and Medicaid create policy related to School-based Medicaid Claiming, it’s up to each State to implement that policy as they see fit. Check with your State’s Department of Education for the specifics! And feel free to reach out to our team any time if you need additional guidance.
After you implement a process for submitting Medicaid claims for your school district, the next thing you’ll want to do is look at how to optimize your reimbursements. You’re already providing students with many great health-related services, but are you recovering all of the costs you can?
Here are just 4 ways to help optimize Medicaid reimbursements for your district:
As we’ve discussed, this changes from State to State and evolves overtime. However, being unfamiliar with what you can bill for, and which students are eligible might mean you’re leaving reimbursement dollars on the table.
Technology can be a game changer when it comes to optimizing reimbursements. Time-saving features can make it easier for providers to enter services while reports and dashboards can highlight areas of opportunity to administrators and your Medicaid billing team.
Submitting Medicaid claims in a timely manner ensures you and your Medicaid billing partner have time to rebill any fixable denials within resubmissions regulations and you can leverage analytics to make informed decisions in real time.
School-based Medicaid claiming differs from State-to-State. Here are a few common differences you’ll want to understand.
Medicaid Eligible Services and Students
States that have taken advantage of the Free Care policy reversal can submit claims for eligible services provided to any Medicaid-enrolled student while others are restricted to only students with an IEP. Additionally, some States bill for services like transportation, nursing, etc. while others do not.
Supervision and Provider Requirements
It’s important to be familiar with your State’s regulations for both supervisor and provider requirements. For example, in some States and for some services, the person administering the services must maintain certain credentials while in others the supervisor’s credentials may be satisfactory.
Group Size Limits and Documentation Requirements
Certain types of Medicaid-eligible services may be provided to a group of students, but that group size and the documentation requirements can vary from State to State.
Getting started with, or taking steps to improve, school-based Medicaid claiming for your district may be easier than you think! While there are many ways to optimize Medicaid reimbursement, regulation/ process changes and other nuances can make it a bit of a moving target. The right Medicaid billing partner and easy to use technology can act as an extension of your team, helping your district recover costs associated with the services they provide.
Key features of school-based Medicaid claiming software
Getting started and/or optimizing Medicaid claims may be easier than you think!
At a minimum, you’ll want to involve your Special Education Director and a Finance leader as you make your first foray into school-based Medicaid claiming. Depending on your State’s billable services, you may extend this team to include representatives from nursing, transportation, and providers.
Use data like the number of students in your district with IEPs and the percent of students on free/reduced lunch to estimate what optimizing your Medicaid claiming program could mean to your district. Add in open/free care and the benefits could be even greater!
If you have questions about anything presented in this eBook or are interested in better understanding how you can optimize the benefits of a school-based Medicaid program, we’re happy to help. No cost. No obligation.
About Go Solutions
Go Solutions is committed to empowering school districts across the US with innovative solutions that positively impact student success and their school communities. From intervention to reimbursement and everything in-between our IEP and Medicaid software, and Medicaid billing team help ensure your district is optimizing participation in the State’s Medicaid reimbursement program and can continue to provide
exceptional experiences for all students.
Have any questions? Let’s talk.