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.
IEP Telemedicine Services During COVID-19 Outbreak
- During the COVID-19 outbreak, IEP-required medical services, such as therapies, nursing and psychologist services, may be provided via telemedicine within the scope of practice of the licensed medical professional and in accordance with the following telemedicine technology-related guidance issued by the U.S. Department of Health and Human Services as well as Indiana Health Coverage Programs Bulletin BT202071 Page 3.
- Indiana Medicaid temporarily expanded coverage for telemedicine services during the COVID-19 outbreak in accordance with the federal guidance referenced above. Billing guidance for these services was updated in September 2020. More details on claiming Medicaid reimbursement for IEP-required services are available in the Medicaid Billing Tool Kit (click link under Manuals below) and at the IDOE Office of Special Education Moodle community.
- To help families determine if their child qualifies for Medicaid/Hoosier Healthwise benefits and for help enrolling in public health coverage programs, click these links:
- Who is eligible: https://fssabenefits.in.gov/bp/#/
- Health coverage enrollment assistance available in each Indiana county: https://www.in.gov/healthcarereform/indiana-navigators/find-a-navigator/
- Non-profit organization offering health coverage enrollment assistance: https://www.ckfindiana.org/
- Medicaid Reimbursements per School Corporation Report – First Half of State Fiscal Year 2021 (7/1/2020 – 12/31/2020): IEP services reimbursements shown on first 10 pages & IndianaMAC reimbursements on last 5 pages.
Additional Resources and Information
- Federal Medical Assistance Percentage (FMAP) Rates 2009-2021 - Corrected 9-29-2020
- 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, 22nd Edition – December 2020 – 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 22nd Edition of the Medicaid Billing Tool Kit – Updated December 2020 – The Update Log identifies what changed from the previous edition of the Medicaid Billing Tool Kit.