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Maximizing Medicaid Billing in Education

By Trish Geraghty

Where did the money go? Anyone else concerned about how to fund everything without ESSER and the always dwindling Title funds?  Medicaid is a critical resource for ensuring students’ access to comprehensive health services within the school setting. With billions of dollars allocated annually by the federal government, the Medicaid program plays a pivotal role in enhancing the well-being of students, particularly those with disabilities. However, despite the significant potential benefits, the utilization of Medicaid funds in education remains underexplored in many states across the US.

 The allocation of significant Medicaid funds to schools highlights the federal government’s commitment to offering physical, mental, and behavioral health services for students that qualify. These funds are instrumental in accessing  a wide array of services, ranging from speech and occupational therapies to supporting activities of daily living in the classroom. 

 One of the key distinctions among states lies in the extent to which their Medicaid plans allow for reimbursement of services provided to Medicaid-eligible students. While most states have plans in place for reimbursing services to students with disabilities under IDEA, only 16 states extend reimbursement to all Medicaid-enrolled students. By explicitly allowing reimbursement for services for all Medicaid-enrolled students, states can unlock additional funds and ensure broader access to crucial health services.

 Medicaid covers more than half of all children and youth who are school-aged nationwide. By making health services available in schools for all Medicaid-enrolled students, the number of students accessing these services can significantly increase, alleviating burdens for families and promoting equitable access to care. Plus, schools get reimbursed for services you have to provide anyway based on the student’s IEP. 

 Financially, Medicaid reimbursement represents a substantial source of funding for many Local Education Agencies (LEAs). For instance, Chicago Public Schools receive $35-40 million annually in Medicaid reimbursement, with expectations of further increases following the federal flexibilities introduced in the 2023 CMS claiming guide. 

 The positives of billing Medicaid for school-based services are financially huge! Hopefully, the information I have shared will motivate you to want to learn more about it. However, there are some downsides to billing for Medicaid. The number one compliant is submitting for billing. There are guidelines to follow to ensure the appropriate information and data are collected and submitted. At first, this can seem like an overwhelming task and not worth the return on investment of your time and energy. There are tools out there that can help! Check out SLPToolkit and Kit to see how you can effortlessly collect the required data and export a Medicaid report to submit for billing. 

 For more information, check out Medicaid Funding for School-Based Services and this “light” (haha) reading of Delivering Services in SchoolBased Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.  

Trish Geraghty
Trish Geraghty, an accomplished educational leader with 20+ years of experience, excels in curriculum development, instructional design, and professional development. Her proven track record includes successful support for schools, districts, educators, and students. Committed to ensuring universal access to high-quality learning, Trish is a visionary advocate for inclusive education. Her innovative approach to curriculum development reflects a keen understanding of evolving standards. Trish's transformative influence extends beyond traditional boundaries, actively contributing to the broader advancement of education. A catalyst for positive change, she inspires excellence in others, shaping the future of education through unwavering commitment and visionary leadership.

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