Just when you think it can’t get any worse, the Federal Government is now attempting to change the rules on Medicaid billing for school services, and that will harm the most vulnerable children in our public schools. This would change whether school districts must obtain parental consent before billing medical services for special ed services that occur within the schools.
Parents in New Hampshire are asked to give their permission for schools to bill Medicaid for certain health services provided to eligible students. State and federal regulations require this consent. Federal regulations state that consent and notification must be obtained before using a student’s Medicaid benefits for the first time and annually after that.
So what would this change in rules do to children receiving special ed services in the schools?
The US DOE is stating:
“As there are no comparable consent requirements prior to accessing public benefits for children without disabilities, the removal of this consent requirement would align public benefits consent requirements for children with disabilities to those for children without disabilities and ensure equal treatment of both groups of children.”
This does not tell the whole story. School districts don’t ask for Medicaid information for children without disabilities because they don’t provide services for those students. But we are seeing comments from school administrators that indicate that asking for consent from parents is an “administrative burden.” Parents have to consent when their Pediatrician requests insurance benefits, but it’s too burdensome for school districts to do the same?
A friend explained it this way:
First, the focus should be on fully funding IDEA; not on drawing from other needed funds. Mixing the funds from IDEA with Medicaid is a terrible idea, and only hurts the special needs child and their ability to get outside services paid for by Medicaid.
Second, the school accessing a child’s medical insurance could have the effect of hindering the child from receiving desperately needed services outside school. VERY IMPORTANT TO NOTE: Schools do not provide clinic equivalent services and therefore should not receive funding intended for medically-necessary clinical services.
For example, if your child is evaluated by a neurologist or treating physician and recommends 5 units of speech per week, and the school system is only recommending 3 units of speech per week, then under the Current Rules, your child is entitled to receive the additional 2 units of speech per week through a private provider under Medicaid based on “prior authorization.” However, under the Proposed Rules, Medicaid can (and will) deny the additional services because it will treat the school-provided services as “medical services” and deny any other “prior authorizations” based on your treating clinician. (Sorry if that is confusing.)
Third, EQUAL treatment of children with and without disabilities is essentially discriminatory since ADA requires EQUITABLE treatment, allowing children to receive treatment according to their level and type of need. One size fits all changes to existing IDEA policy is a step backward for disability and education rights.
Parents need all the necessary knowledge to make informed decisions about their children’s healthcare. Parents currently have the right to withdraw their consent to bill Medicaid for school services if they have any concerns or preferences that warrant such a choice.
The fundamental right they have is the right to privacy. If you have any reservations about sharing your child’s personal and medical information with the school and Medicaid, you can choose to withdraw your consent. Protecting their children’s sensitive data and making decisions that align with their comfort levels is essential.
Additionally, suppose you feel that the Medicaid-funded services provided by the school have limitations or restrictions that don’t meet your preferences or expectations. In that case, parents have the right to explore alternative service providers. Their children’s care should align with their specific needs and offer comprehensive support. Parents have the power to seek out services that better meet those requirements.
Parents have access to other healthcare resources or private insurance that they prefer to use sometimes instead of solely relying on Medicaid for services provided at school. It’s within their rights to make decisions that they believe will offer their children more specialized or higher-quality care.
As parents of children with disabilities, they have the right to ensure the smooth implementation of their child’s Individualized Education Program (IEP) or 504 plan. If parents are concerned that billing Medicaid for school services could impact the coordination between Medicaid-funded services and their child’s educational accommodations, parents have the right to withdraw their consent.
It’s important to note that if parents withdraw their consent, the school district will continue to provide all the necessary services required for their child’s education at no charge, as the relevant regulations are required for appropriate education (34 CFR § 300.154(d)(2)(v)(D)) . Their decisions won’t impact the quality of education and support their children receive.
Parents can request billing and claim records from their Managed Care Organizations (MCO) and their child’s school if they wish to review the details of the Medicaid billing.
NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID TO SCHOOLS BILLING AND POLICY GUIDANCE Reference Number SFY 2020-
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NH Medicaid to School, also known as the School Medicaid Administrative Claiming (SMAC) program, is a New Hampshire program allowing public schools to seek reimbursement from Medicaid for certain health-related services provided to eligible students. These services can include various activities such as screenings, assessments, counseling, speech therapy, occupational therapy, and transportation related to medical services.
Under this program, schools can bill Medicaid for services provided to students who are eligible for Medicaid and receive special education or related services through an Individualized Education Program (IEP) or a Section 504 plan. NH Medicaid to School aims to ensure that students with disabilities or special healthcare needs can access the necessary services and supports to succeed in the educational setting.
The Medicaid reimbursement obtained through NH Medicaid to School can help schools offset the costs associated with providing these services. It is important to note that parents typically need to provide consent for their child’s school to bill Medicaid, and they have the right to withdraw consent at any time.
Specific procedures and guidelines for the NH Medicaid to School program may be outlined by the New Hampshire Department of Education or the New Hampshire Department of Health and Human Services. Parents seeking to withdraw their consent for Medicaid billing should follow the steps outlined by these agencies and consult with relevant professionals or legal experts to ensure they navigate the process properly.
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As a parent, it’s important to know that you have the right to consent or withdraw consent for your child to receive Medicaid-funded services through their school district. If you want to withdraw your consent for your child to receive these services or for the school district to bill Medicaid for your child’s services, follow these steps:
1. In writing, notify your child’s school district by emailing your superintendent, carbon copy(cc:) your entire IEP Team, and your Managed Care Organizations (MCO); WellSense, NH Healthy Families, AmeriHealth Caritas New Hampshire that you are withdrawing consent for Medicaid billing or services.
Your written notice should include the following:
**Your child’s name
**Date of birth, and
**A clear statement that you are withdrawing consent for Medicaid-funded services.
2. Suppose your child is currently receiving Medicaid-funded services through the school district. In that case, in writing, you should also notify the service providers and any other relevant school staff in writing that you are withdrawing consent for Medicaid billing or services.
Your written notice should include the following:
**Your child’s name
**Date of birth, and
**A clear statement that you are withdrawing consent for Medicaid-funded services.
Complete the section below ONLY if parent/guardian is withdrawing consent to access to the child’s Medicaid.
WITHDRAWAL OF CONSENT
Student Name: ____________________________________ Date of Birth______/_______/______
Medicaid ID Number______________________________________
As the parent/guardian of the above student, I withdraw my consent to allow the school district to access the child’s Medicaid. I understand that this means that the school district will no longer be able to use my child’s Medicaid to help pay for my child’s special education and related services. This withdrawal of consent is effective upon the school district’s receipt of the parent/guardian’s signed Withdrawal of Consent form.
Parent’s Signature _________________________________________
Today’s Date _________________________________________
Original to student’s file—–copy to parent/guardian(Page 34 New Hampshire Special Education Procedural Safeguards Handbook)
3. Once the school district receives your written notice, they should stop billing Medicaid for your child’s services. They should not provide further Medicaid-funded services to your child unless you provide written consent again.
4. Request that your letter withdrawing consent is added to your child’s education file. The Family Educational Rights and Privacy Act (FERPA) Please add this document to my child’s educational file.
5. It is important to note that withdrawing consent for Medicaid billing or services does not impact your child’s eligibility to receive special education or related services through their school district. The school district is still responsible for providing these services to eligible students with disabilities, regardless of Medicaid funding.
If you have any questions or concerns about withdrawing consent for Medicaid-funded services or billing, contact your child’s school district’s special education director or Medicaid School Director for guidance and support.
