The US Department of Education (ED), has been an important partner in developing school-based guidance with the Medicaid Program. This continued collaboration seeks to build upon the comprehensive guidance and provide further materials and resources to States and Local Education Agencies (LEAs) in accomplishing the goal of increasing the number of IDEA and other Medicaid-eligible services in the school-based setting.
Guarantee of Services under IDEA:
Regulations at 34 C.F.R. Section 300.154(b)(1)-(2) discuss the “Obligation of noneducational public agencies” (including managed care entities)- clarifies that Medicaid services provided in school under IDEA for ensuring Free Appropriate Public Education (FAPE), “…may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context.”
IDEA Services and Medicaid:
Generally, IDEA services must be provided for free with no co-pays or other cost sharing, and Medicaid can be the payer of first resort. Limiting Medicaid services outside of the school setting, based on provided Medicaid eligible IDEA services in schools, is unallowable, even under managed care contracts. This is based on regulations at 34 C.F.R. Section 300.154(b)(1)-(2) & 34 C.F.R. 300.154(a) that discuss interagency agreements and coordination. Specifically, “A noneducational public agency described in paragraph (b)(1)(i) of this section may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context.”
Obligation of noneducational public agencies.
(1) (i) If any public agency other than an educational agency is otherwise obligated under Federal or State law, or assigned responsibility under State policy or pursuant to paragraph (a) of this section, to provide or pay for any services that are also considered special education or related services (such as, but not limited to, services described in § 300.5 relating to assistive technology devices, § 300.6 relating to assistive technology services, § 300.34 relating to related services, § 300.42 relating to supplementary aids and services, and § 300.43 relating to transition services) that are necessary for ensuring FAPE to children with disabilities within the State, the public agency must fulfill that obligation or responsibility, either directly or through contract or other arrangement pursuant to paragraph (a) of this section or an agreement pursuant to paragraph (c) of this section.
(ii) A noneducational public agency described in paragraph (b)(1)(i) of this section may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context.
Resources:
Joint Guidance on the Application of FERPA and HIPAA to Student Health Records
IDEA and FERPA Crosswalk - A side-by-side comparison of the privacy provisions under Parts B and C of the IDEA and FERPA.
“A Parent Guide to the Family Educational Rights and Privacy Act (FERPA)” to help parents understand their rights. FERPA (20 U.S.C. § 1232g; 34 C.F.R. Part 99), provides certain rights for parents regarding their students’ education records.