Over my years as a special education director and work in the ed tech sector, I have often heard from districts that the burden of documentation and other rules are too great for them to actively claim Medicaid reimbursement. For some, the amount of time needed to maintain and track all documentation required equates to a full-time job or more! Schools in those circumstances are left feeling as though there is no good return on investment. In other schools, I have heard Medicaid reimbursement is the only thing allowing them to continue comprehensive or innovative programming for students with disabilities.

What makes Medicaid such a nebulous beast? For starters, Medicaid reimbursement for special education services and related services varies by state. In most states, schools must provide explicit documentation on the student’s behalf to qualify for reimbursement for services such as speech/language therapy, psychological counseling, occupational therapy and other related therapies. This is often done by documenting the services provided to students identified as students with disabilities through an individual education program (IEP). In other states, if services are identified within a Section 504 Accommodation Plan, schools can document and receive reimbursement for certain related services. And in other states, personal care aide time with a student and behavioral support can also be reimbursed through Medicaid.

Fortunately, there are a few items that remain constant across all states: 

• Schools must obtain parental consent prior to submitting claims for reimbursement through Medicaid. 
• Schools must also maintain documentation of each service delivered to a student.

As simple as those two constants may be, there are still complications. Often, parents do not fully understand why the school is seeking their one-time consent to use Medicaid for their child’s special services. Alternatively, they might be fearful of losing their own Medicaid or Medicare benefits if they sign the school’s consent. Articulating that a family’s benefits are in no way affected by the school requesting Medicaid reimbursement is key to helping parents understand what they are consenting to. Some districts have also found success by proactively alerting parents to the types of programming and resources paid for by the reimbursement that the district receives.

Additionally, schools must also have the related services delivered by appropriately credentialed staff. As part of that, schools must maintain documentation of each service delivered to a student. Again, the specifics for which credentials meet the guidelines for reimbursement and how specific and detailed the documentation must be varies greatly from state to state.

It is no surprise then that many districts struggle with using Medicaid – what should be a significant benefit can feel like a cumbersome process. Combined with budget constraints and the ever-changing rules and regulations, it’s no wonder that many districts choose to opt out. But don’t let Medicaid and its many hoops prevent you from receiving its benefits. While it may seem like a curse to have to navigate its criteria, it can be a cure that allows funding for innovative services to and other resources for the kids most in need. of them. 

A great way to get started is by partnering with the Magnolia Consulting Group – we can help you move through the Medicaid in education quagmire to set up a system that works best for you and your team. We can increase your return on investment and help with analyzing your systems while recommending management systems to streamline your processes. If you’re ready to get started and receive the benefits from Medicaid to best support your students, contact us at [email protected]!