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Medicaid in Education

School districts in Oregon have long been able to seek reimbursement for services they provide to IDEA eligible students. School Districts can Leverage Medicaid on covered health related services that match the early intervention, early childhood special education, and special education services provided to Medicaid eligible children eligible under the IDEA. In order to bill Medicaid, a service must be required and reflected in the child’s IFSP or IEP. There are three IDEA programs in Oregon including:

  • EI (ages birth to 3)
  • ECSE (ages 3 & 4)
  • School-age K-12 (ages 5 to 21)

SB 111 (School Medicaid Pilot Project)

SB 111 (2017) requires the Oregon Department of Education (ODE) to assist schools in funding school nurse services through increased SBHS Medicaid billing. As part of this pilot project, ODE will submit a report that includes a cost benefit analysis to the interim committees of the Legislative Assembly related to education no later than October 1, 2020. SB 111 states:

(4) Technical assistance provided to a school district or an education service district under this section shall include the following

  1. Assistance in the creation and implementation of a district plan to maximize Medicaid billing for school nursing services as part of the overall structure for providing school health services;
  2. Assistance to school nurses with practices related to Medicaid billing and efficiencies; and
  3. Ongoing technical assistance to participating school districts and education service districts in maximizing Medicaid billing.

General Information, Guidance, Oregon Administrative Rules

Information and Resources Related to Service Documentation

State Medicaid (Oregon Health Authority)

ODE Written Notice and Consent

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