Medicaid

Medicaid in Education

Since 1988, states have been able to leverage federal Medicaid funds to help offset costs for school-based health related services required by the IDEA, when provided to Medicaid-eligible students. School Medicaid can be leveraged for covered health related services that are considered early intervention (EI), early childhood special education (ECSE), and special education services provided to Medicaid-eligible children who are also eligible under the IDEA. EI covers birth to age three, ECSE covers ages three to five, and special education covers ages five through twenty-one.

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. 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 Medicaid Billing Manual - Update Coming Soon!
• School Based Health Services, where IDEA and Medicaid intersect
• School Based Medicaid visual

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.
• Occupational Therapy in Oregon Schools
• Physical Therapy in Oregon Schools
• Nurse Staffing in Oregon Schools
• Medical Health Assessment Statement

State Medicaid (Oregon Health Authority)

• Oregon Health Authority School-Based Health Services Medicaid Information
• School-Based Health Services Administrative Rulebook
• School Medicaid Billing Checklist
• Medicaid Leveraging Flow Chart

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)
• Parental Consent for Families Infographic
• Parental Consent for Families Infographic - Spanish Language Version (Courtesy of Hillsboro School District)

For more information contact:
Email: Ely Sanders
503-947-5904 or

Email: Jennifer Ross
503-947-0504