School-based services

The Office of Superintendent of Public Instruction (OSPI)  is the primary agency charged with overseeing public K–12 education in Washington state. Working with the state's 295 public school districts, charter schools, and 6 state-tribal education compact schools, OSPI allocates funding and provides tools, resources, and technical assistance so every student in Washington is provided a high-quality public education.

Learn more about Washington school districts.

Background

School-based services (SBS) are Medicaid-covered health care services provided to students in Washington state public schools. These services include:

• Public school districts Medicaid administrative claiming (MAC)
• School-based health care services (SBHS)
• Schools contracting with managed care organizations (MCO)

School-based services expansion

In response to the Centers for Medicare and Medicaid’s (CMS) recently released guide for delivering services in school-based settings, the Health Care Authority (HCA) established a chartered workgroup to:

1. Evaluate HCA’s existing SBS Medicaid programs and make recommendations to ensure compliance with the CMS SBS Guide.
2. Complete an assessment to inform recommendations and implement improvements regarding SBS.

School-based services resources

Federal resources

• CMS overview of Medicaid and school-based services
• CMS Delivering Services in School-based Setting guide
• CMS guide fact sheet
• Technical Assistance Center (TAC)
• CMS SBS TAC upcoming events
• CMS SBS TAC frequently asked questions
• US Department of Education and School-based Services

National Association of Medicaid Directions (NAMD) resources

• NAMD Medicaid funding for school-based services

Healthy Schools campaign resources

• Healthy Students, Promising Futures
• Healthy Students, Promising Futures Medicaid fact sheet

School-based Behavioral Health Services and Billing Toolkit

The Medicaid School-Based Behavioral Health Services and Billing Toolkit provides guidance on how public schools can access Medicaid funding for non-Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) school-based behavioral health services through the Medicaid managed care organizations and fee-for-service programs.

The toolkit also provides behavioral health resources and supports, directions on how to become a behavioral health agency, and best practices for billing Medicaid.

The toolkit is focused on reimbursement for behavioral health services, but public schools may also be able to receive reimbursement for other non-IEP Medicaid-covered services provided in the school setting. Public schools are encouraged to discuss other covered services with MCOs.

Public school districts Medicaid Administrative Claiming

Medicaid Administrative Claiming (MAC) is a program available for governmental entities that interact with individuals who are, or may be, eligible for Washington Apple Health (Medicaid).

The Public School District MAC program provides public schools with partial reimbursement for the time their staff spend performing administrative activities that support the State's Medicaid Plan, such as:

• Apply for Apple Health, including renewals.
• Explaining the Apple Health program.
• Helping individuals access Apple Health services.

How can I participate?

To participate in the program, you must:

• Be a governmental entity.
• Be contracted with HCA.
• Participate in a time study designed to identify the percent of time you spend performing the Medicaid administrative activities listed above.

Learn more about MAC for public school districts.

School-based health care services

School-based health care services (SBHS) is an optional Apple Health program that provides reimbursement to public schools for certain early intervention health-related services or special education health-related services. This program is fee-for-service and is not covered through managed care.

These services are reimbursable when a student has Title XIX (19) Medicaid (CNP/MNP) coverage and the services are included in the student's current IEP or IFSP.

Learn more about SBHS.

Schools contracting with managed care organizations

Public schools can contract directly with the Medicaid managed care organizations (MCO) to receive reimbursement for providing Medicaid-covered health services not included in an IEP or IFSP.

Examples of services that public schools may receive reimbursement for include:

• Vision and hearing screenings
• Diabetes and asthma treatment for students with 504 plans
• Behavioral health services
• Immunizations
• Any other non-IEP/IFSP Medicaid-covered health service

Learn more about contracting with managed care organizations.