Federal law makes Medicaid reimbursement available for health-related services that schools provide to address the educational needs of students. By law, Medicaid claiming for Individualized Education Program (IEP) services cannot affect the student’s Medicaid eligibility or benefits. Subject to parental consent, participating Indiana public school corporations, including public charter schools, may claim Medicaid reimbursement for covered IEP services, such as therapies, nursing, mental health, audiology, and specialized transportation. Indiana public school corporations may also participate in school-based Medicaid Administrative Claiming (IndianaMAC) to recover a portion of their state and local costs for administrative support activities to help students with unmet health needs. Federal Medicaid dollars help schools fund a variety of student supports, including specialized equipment, qualified personnel, professional development, on-site medical services, and supplies.
Expanded Coverage of IEP Telemedicine Services During COVID-19 Outbreak
Governor’s Executive Order 20-13, COVID-19 Medical Surge: Please carefully review, especially sections 2.a., 5.b. and 5.d.
- Federal Government Relaxes HIPAA Restrictions Allowing Everyday Telecommunications Technologies for Medical Service Delivery during COVID-19 Outbreak.
- Indiana Health Coverage Programs (Medicaid) Bulletin BT202022 Announces Expanded Telemedicine Coverage During COVID-19 Outbreak.
- Emergency COVID-19 Billing Codes for IEP Telemedicine Services
- Indiana Medicaid COVID-19 discussion, including telemedicine policy (March 23, 2020): View at link accessible under Past Webinars (Recorded Presentations) at https://www.in.gov/medicaid/providers/1014.htm
- Medicaid Reimbursements per School Corporation Report – First Half of State Fiscal Year 2020, as of 12/31/2019: IEP Services (pages 1-10) & IndianaMAC (last 5 pages)
Additional Resources and Information
- Federal Medical Assistance Percentage (FMAP) Rates 2009-2020
- Frequently Asked Questions: Medicaid Funds Use; Federal Medicaid Match Rates; and State Medicaid Match Funding Sources
- Frequently Asked Questions: School Corporation Medicaid Provider Enrollment
- Indiana Medicaid Coverage Policy Q&A: IEP Speech-Language Services
- Healthy Students, Promising Futures: State and Local Action Steps and Practices to Improve School-Based Health - U.S. Department of Education web site
- What is IndianaMAC? A one-page overview of school-based Medicaid Administrative Claiming
- Indiana MAC Time Study Participant Manual - Updated July 2016
- Medicaid Billing Guidebook - Updated December 2017 - The Guidebook is a high-level overview of Medicaid claiming for school-based health services and related administrative activities in Indiana.
- Medicaid Billing Tool Kit, 21st Edition – June 2019 – The Tool Kit discusses Indiana Medicaid billing requirements for covered health-related services in a student’s IEP. It includes general billing guidelines for all IEP-required medical services, as well as coverage limitations, Medicaid provider qualifications, and other billing details applicable to each type of Medicaid-covered IEP service.
- Update Log for the 21st Edition of the Medicaid Billing Tool Kit – Updated June 2019 – The Update Log identifies what changed from the previous edition of the Medicaid Billing Tool Kit.