Medicaid

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.
   • Senate Bill 111. School Medicaid Pilot Project (2017)
   • ODE Selects 9 School Districts for School Medicaid Billing Pilot

General Information, Guidance, Oregon Administrative Rules

• School District Medicaid Quality Assurance Plan (QMAP).
• School Based Health Services, where IDEA and Medicaid intersect
• School Based Medicaid visual
• School-Based Health Services Administrative Rulebook.
• Guidance to School Districts and Education Service Districts School Based Health Services Medicaid Billing Issued May 15, 2018 (Updated 6/6/18).
  • ESD Webinar – (YouTube Link)
  • Slides (PDF)
• Information to school districts related to recent guidance issued by the Oregon Department of Education regarding School Based Medicaid Billing.
• Parental Consent Infographic

Information and Resources Related to Service Documentation

• Guidance for Medicaid and the IEP
• Documentation Recommendations and Requirements for Licensed School Health Staff Working in a School Setting
• Documentation to support Medicaid Reimbursement for Health Services on IEP/IFSP Presentation 8/6/18.
• Documentation and Delegation templates:
  • Delegated Task Documentation Form
  • Nursing Delegation Form
  • School Nursing Documentation Form
  • Transportation Log

State Medicaid (Oregon Health Authority)

• Oregon Health Authority School-Based Health Services Medicaid Information
• Provider Enrollment Summary

ODE Written Notice and Consent

• Written Notice to Parent, Proposed Use of Public Insurance by School District/ECSE Program
• Written Consent to Access Public Insurance (Medicaid)