Medicaid to Schools Program

• What is the Medicaid to Schools Program?

• Who is Eligible for the Medicaid to Schools Program?
• What Services Are Covered?
• How do Schools Participate and Receive Payment?

What is the Medicaid to Schools Program?

Under NH Law, RSA 186-C, public schools are required to provide certain services to students with special education needs which are specified in an Individualized Education Plan (IEP). These services include certain medical services and supports. In 1988 changes in Federal Law allowed schools to seek partial reimbursement for some services under the Federal Medical Assistance Program, Title XIX of the Social Security Act, also known as Medicaid. In 1990, NH enacted Chapter 272, which authorized the creation of a special Medicaid program to pay for medically related services in a student's IEP.

Who is Eligible for the Medicaid to Schools Program?

In order to be eligible for Medicaid coverage for medically related services under this program a student must

• Be covered by Medicaid;
• Be identified as having an educational disability and have an Individualized Education Plan (IEP) in accordance with RSA 186-C, the Special education law in New Hampshire;
• Be less than 22 years of age; and
• Be served by a public school district that has agreed to be a Medicaid Provider and completed an Enrollment Application.

What Services Are Covered?

The following medically related services within a Medicaid eligible student's IEP are covered

• Medical Exams and Evaluations
• Mental Health Services
• Nursing Services
• Occupational Therapy
• Pre-school Services
• Psychiatric Services
• Psychological Services
• Physical Therapy
• Rehabilitative Assistance
• Specialized Transportation
• Speech, Language and Hearing Services
• Supplies and Equipment related (i.e. one- on- one health aide) to vision, speech, language and hearing services, occupational, physical therapy services, and nursing supplies
• To Covered Services
• Transportation To Medical Appointments
• Vision Services

Qualified staff specified in the program's rule must provide all services and some services require referrals or orders from physicians or other health care related professionals, which are also specified within the rules.

How do Schools Participate and Receive Payment?

Districts begin by becoming enrolled Medicaid Providers. Enrollment Applications are available from New Hampshire 's Medicaid Fiscal Agent, Electronic Data Systems, (603) 225-4899. In addition, Electronic Data Systems provides free software, installation and training for districts to implement electronic claims submission, and to assist with billing related issues.

The districts obtain the Medicaid identification numbers of eligible students from their families/caregivers, submit special claim forms or bill electronically to Electronic Data Systems for payment.

Districts receive 50% of their actual cost for the provision of covered services or 50% of the rate for the service established by the State of N. H., whichever is less.

Information and training are available at no cost on requirements within the rules, how to start the program, how to bill and track Medicaid payments, etc.

To Start the Process or for Further Information