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U.S. Department of Education School-Based Services Resources

The U.S. Department of Education (ED) has been an important partner in developing school-based guidance with the Medicaid program. This continued collaboration builds on comprehensive guidance and gives more materials and resources to states and local education agencies (LEAs) to increase:

  • The number of Individuals with Disabilities Education Act (IDEA)
  • Other Medicaid-eligible services in the school-based setting

IDEA services & Medicaid

Regulations

  • Discuss the “Obligation of noneducational public agencies” (including managed care entities)
  • Clarify 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”

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. Based on regulations at 34 C.F.R. Section 300.154(b)(1)-(2) and 34 C.F.R. 300.154(a) that discuss interagency agreements and coordination, It’s unallowable, even under managed care, to limit Medicaid services outside of the school setting based on provided Medicaid-eligible IDEA services in schools.

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.”

Resources