Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
How are SBS provided to Medicaid eligible children under IDEA?
Part B of IDEA provides Federal funds to SEAs, and SEAs subgrant a majority of IDEA funds to LEAs and school districts. IDEA funds assist SEAs and LEAs in providing a free appropriate public education (FAPE) to eligible children (generally ages 3 through 21) with disabilities through the provision of special education and related services. As explained below, Medicaid is a funding source for special education and related services for Medicaid enrolled children.
An Individualized Education Program (IEP) is a written statement for a child with a disability that is developed, reviewed, and revised in accordance with IDEA’s requirements in 34 C.F.R. §§ 300.320 through 300.324. A child’s IEP addresses, among other things, the nature, frequency, duration, and location of a child’s special education, related services, supplementary aids and services, and program modifications and supports for school personnel. Services provided under IDEA Part B are provided at no cost to the child’s parents.
For Medicaid-enrolled children who receive services under IDEA Part B, IDEA specifically requires States to create an interagency agreement or other mechanism that must include provisions stating that the State Medicaid agency financial responsibility precedes the financial responsibility of the LEA (or the State agency responsible for developing the child's IEP). Therefore, Medicaid is payer of first resort (as between Medicaid and LEAs or the State agency responsible for developing the child's IEP for Medicaid-covered services included in the IEP (see section 1903(c) of the Act and IDEA sections 612(e) and 640(c), codified at 20 USC 1412(e) and 1440(c); 34 C.F.R. § 300.154(h); and 42 C.F.R. § 433.139)).
FAQ ID:166471
SHARE URLWhat are some examples of child find activities?
Examples of child find activities can include:
For preschool- and school-aged children: Public awareness campaigns by the LEA or in partnership with a school’s parent teacher association that include information provided in languages spoken in the community and that target a wide audience, including parents and families, daycare and early childhood education providers, summer camps, medical providers, homeless shelters, religious institutions, and kindergarten roundup (i.e., events hosted by elementary schools to facilitate a child’s transition from home to formal education).
For older children:
- Locally administered assessments that measure student academic growth.
- Screening private school students and home school students.
- Meeting with mental health practitioners.
- Sharing information with nonprofit organizations that focus on families and children.
- Coordinating with State agencies that provide services to children and young adults.
Other activities can include the LEA’s outreach efforts and interagency collaboration with housing programs, such as those funded by the U.S. Department of Housing and Urban Development, that help to identify children who are homeless and may be in need of special education.
If the state is limiting Medicaid coverage to those services included in the IEP/Individualized Family Service Plan (IFSP), then child find services that do not result in an IEP/IFSP being issued are generally not Medicaid coverable services. If the state has broader coverage beyond services described in an IEP/IFSP, then child find services could be coverable regardless of whether an IEP/IFSP has been issued.
Managed Care
FAQ ID:166411
SHARE URLAre any child find activities and initial evaluations covered under the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit?
Yes, some child find activities could be covered in Medicaid. Child find activities may involve a formal screening process to determine whether the child should be referred for an evaluation to determine whether a child has a disability and the nature and extent of the special education and related services that the child needs. In a scenario where a child is enrolled in Medicaid, a screening or initial evaluation could be coverable under a 1905(a) benefit category. As specified in section 1905(r)(5) of the Act, EPSDT entitles most eligible Medicaid-enrolled children and adolescents to services and treatments that fit within any of the benefit categories of Medicaid-coverable services listed in section 1905(a) of the Act if medically necessary, as determined by the State, to “correct or ameliorate” identified conditions. For a child who is not yet enrolled in Medicaid, the child find activities such as screenings and evaluations would not be covered.
More on Child Find is available at the Department of Education’s website.
FAQ ID:166401
SHARE URLWhat is child find under IDEA Part B?
IDEA child find requires States to ensure that all children with disabilities residing in the State who need special education and related services are identified, located, and evaluated, regardless of the severity of the disability, and includes identification of children who are suspected of having a disability. States are responsible for implementing child find activities for all children with disabilities residing in the State, including those children who are experiencing homelessness or are wards of the State, highly mobile and migrant children, English learners, and parentally placed private school children with disabilities, as well as those suspected of having developmental delays as defined in 34 C.F.R. § 300.8(b).
Child find activities are defined in 34 C.F.R. § 300.111 and typically involve a screening process to determine whether the child should be referred for an evaluation to determine eligibility for special education and related services. States must identify, locate, and evaluate all children with disabilities residing in the State and who may need special education and related services.
FAQ ID:166396
SHARE URLHave there been any alterations to Medicaid coverage of child find activities as a result of the 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming?
The 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming (p. 15) has language that states that “coverable services also include child find evaluations and reevaluations.” Medicaid may cover child find screening, evaluations, and reevaluations in certain circumstances (see FAQ on Child Find Activities).
FAQ ID:166406
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