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Medicaid in Education

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Title XIX of the Social Security Act established a federal-state matching entitlement program to provide medical assistance for certain low-income individuals. This program, Medicaid, was enacted in 1965. In 1988, Congress expanded the program with the passage of the Medicare Catastrophic Coverage Act, which requires Medicaid to be primary to the U.S. Department of Education for payment of health-related services provided under the IDEA. The Medicaid program is jointly funded by federal and state governments and is administered by each individual state. The Oregon Health Authority (OHA) is Oregon’s State Medicaid Agency.  School districts can utilize two Medicaid billing programs to optimize Medicaid billing: (1) School Based Health Services (SBHS) Medicaid billing and (2) Medicaid Administrative Claiming (MAC).

  1. SBHS Medicaid Billing: Is a cost-sharing program that allows school districts to seek reimbursement for eligible health-related services provided in the school setting under the IDEA for services pursuant to an IEP.
  2. Medicaid Administrative Claiming (MAC). Provides reimbursement to school districts for activities related to the administration of Medicaid. This includes activities such as referrals to medical or dental services, assisting a student in enrolling in the Oregon Health Plan, and care coordination of Medicaid services.

Use this link to access the OHA’s School-Based Health Services Medicaid Information Webpage.


Jennifer Dundon