State lawmakers get overview of school-based Medicaid program

FRANKFORT, Ky. (WTVQ) – Members of the Kentucky General Assembly’s Medicaid Oversight and Advisory Committee heard from several representatives of the Kentucky Department of Education (KDE) and the Kentucky Department for Medicaid Services (DMS) during the committee’s meeting on Aug. 17.

DMS Commissioner Lisa Lee and KDE associate commissioner Robin Kinney joined the meeting to share updates on the School-Based Medicaid Services Program.

The School-Based Medicaid Services program is a partnership between KDE and DMS that allows schools to receive federal funds for certain services provided to Medicaid-eligible children in schools. To participate in the program, schools enroll in Medicaid as heath service providers.

Not all schools who participate in the program are given the same amount of funds. Schools must submit annual cost reports that help determine the actual price of providing those services for each school. Schools pay the state match for the services they provide – about 30% percent for services provided directly to children, such as speech therapy and physical therapy, and 50% for administrative work required for claims.

Lee said that typically the services a child needs are outlined in their Individualized Education Program (IEP), which allows states to draw down federal funds to pay for school-based health-related services required by the Individuals with Disabilities Education Act (IDEA), when provided to Medicaid-eligible children with disabilities.

Covered services include physical therapy, occupational therapy, psychological counseling, nursing, transportation and IEP evaluations.

“In April 2019, we expanded care in schools to allow them to provide services outside of a child’s IEP and can include any service covered by Medicaid, as long as the appropriate individual or provider is qualified to deliver that service,” said Lee.

All children enrolled in Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) are eligible to receive school-based services, with the exception of about 46,000 children enrolled in the Separate Program portion of KCHIP.

“We would like to make some policy changes that would allow those children to be enrolled in school-based services and receive the same benefits as the majority of the other children do,” said Lee.

Lindsey Kimbleton, a federal program specialist with KDE, discussed the work KDE and DMS are doing to encourage more schools to enroll in the program.

Out of 171 Kentucky public school districts, 163 districts currently participate in the School-Based Medicaid Services program. Kimbleton said there could be several reasons why the remaining eight districts are not currently participating. One reason is that often school districts use their federal IDEA funding to  pay their therapists and other health care providers, which does not allow the providers to request Medicaid back.

“Using federal funds to employ therapists, then requesting reimbursement would be considered double dipping, which isn’t allowable,” said Kimbleton.

Other reasons schools may not participate is the lack of manpower required to start the program, and districts may not have enough students who are billable to make it worth their time. However, Kimbleton said now that expanded access is part of the school-based Medicaid program, she is optimistic that more schools will enroll.

DMS and KDE work together to provide districts with annual training, an updated Technical Assistance Guide (TAG), updates on KDE and DMS websites and open communication with DMS, KDE and billing agents.

“KDE and DMS working together is crucial for this program,” said Kimbleton.

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