Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming

While schools are a setting for and can be providers of Medicaid and CHIP-covered services, the State Medicaid/CHIP agency has the leading role in determining which services are covered by Medicaid and CHIP when furnished in or by schools and how school-based providers are paid. Therefore, the rules vary greatly depending on the state and are generally quite complex. It is often difficult for individual schools and school districts to understand and properly comply with such varied laws. This results in substantial losses in funding for Local Education Agencies (schools and school districts) across the country.

The Centers for Medicare & Medicaid Services (CMS) has created a guide to provide direction to State Medicaid/CHIP agencies and Local Education Agencies to deliver school-based services in a manner that allows Local Education Agencies to obtain all the payments for which they can qualify and to increase access to covered services for enrolled students. The guide covers a wide variety of topics, from the scope of Medicaid & CHIP services in schools to the general billing requirements across the country. The complete guide can be found here.