New School Medicaid Provider Guide is now posted
This resource can help you establish and maintain a strong School-Based Health Services Medicaid program. Please use it alongside Medicaid policy and Oregon Administrative Rules.
View the new School Medicaid Provider Guide
About SBHS
Direct Services: K–12 provides reimbursement to school districts and Education Service Districts (ESDs) for covered health services provided in school settings, pursuant to an Individual Plan of Care (IPOC). There is no requirement for education agencies to bill for K–12 direct services.
Direct Services: EI/ECSE provides reimbursement to Early Intervention/Early Childhood Special Education (EI/ECSE) programs contracted with the Oregon Department of Education (ODE) for Medicaid-covered health services provided to children birth to five years old (pre-K), pursuant to an IPOC. ODE contractually requires EI/ECSE programs to bill Medicaid.
Medicaid Administrative Claiming (MAC) provides reimbursement to ESDs through a MAC intergovernmental agreement (IGA) with OHA and to school districts and ESDs under a MAC sub-agreement with ESDs who hold a MAC IGA for activities related to the administration of Medicaid including referrals to and coordination and monitoring of Medicaid covered health services, assisting a student or family to enroll in the Oregon Health Plan (OHP), and planning, assessment, and policy development of health services programs.