FCSN // Newsletter // 2019 // Fall 2019 // School-Based Medicaid:  Expansion Update
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School-Based Medicaid:  Expansion Update

By Pat Nemia, Project Director of Mass. Family Voices

For the last several years, the Massachusetts School-Based Medicaid Program (SBMP) has allowed Local Education Agencies (LEAs) to bill MassHealth for medically necessary services provided at school to children on MassHealth that are also on an Individualized Education Program (IEP). 

Examples of medically necessary or direct services are speech-language therapy, occupational therapy, and physical therapy. The reimbursement for these services results in federal dollars coming to the cities and towns in which these children live.

Beginning July 1, 2019, the IEP requirement expanded to also include reimbursement for services to school children on MassHealth that have an Individualized Family Service Plan (IFSP) for infants and toddlers in Early Intervention, an Individual Health Care Plan (IHCP), a Section 504 plan, or services that are deemed medically necessary.

In addition, the reimbursable service types expanded to include dental hygienist, nutritionist/registered dietitian, respiratory therapist, and school psychologist licensed by Department of Elementary and Secondary Education.

The MassHealth Bulletin will provide the specifics of services and provider types involved in the expansion at this link: https://www.mass.gov/files/documents/2018/05/23/sbm_31_1.pdf

Parental consent is still required for the LEAs to bill MassHealth for services provided to their child at school. The consent will now be a one-time consent signed by parents rather than an annual consent form. Parents always have the right to revoke consent in writing to the LEAs.

For information about the consent process, review this link from the Department of Elementary and Secondary Education (DESE) http://www.doe.mass.edu/sped/advisories/13_1.html.

For questions or more information:

Visit School-Based Medicaid Expansion website: https://www.mass.gov/masshealth-school-based-medicaid-program

Call Mass Family Voices: 800-331-0688 x301