Is your school district leaving school-based Medicaid reimbursement funding on the table? What if you could maximize the reimbursements you receive for your Medicaid-eligible students, in both regular and special education?
When school districts provide healthcare and support services to eligible, Medicaid-enrolled students—like kids with cognitive or developmental delays, ADHD, or impairments in hearing, vision or speech—school-based Medicaid claiming and billing processes let schools recover a portion of the costs from State and Federal Medicaid programs. These services are organized through individualized education plans (IEPs), Individual Family Plans (IFSPs), or additional plans that vary by state. Depending on your state’s plan, additional services for Medicaid-eligible students might be reimbursable for those on chronic care, 504, behavior and speech improvement plans!
But with all the ins-and-outs of the program requirements and IEP processes, if schools aren’t aware of certain best practices, they might be leaving important Medicaid funding behind—Medicaid funding that could be furthering students’ education in additional ways.
As we head into 2025, school districts must focus on effectively navigating Medicaid billing reimbursements more than ever before. At Go Solutions, we help school districts optimize their Medicaid reimbursements. As you’ll see below, timing is crucial in securing these funds. Here are the top eight best practices for school-based Medicaid billing that we recommend to our customers:
1. Be Persistent in Obtaining Parental Consent
Obtaining parental consent is the first step in getting the ball rolling for Medicaid reimbursements. Without parents signing the consent form, schools cannot submit claims or receive reimbursements.
By signing the consent form, parents consent to the school district releasing certain information to government agencies. This information simply confirms that the school district is providing medically necessary services for their child, as identified in the child’s IEP, IFSPs, or additional plans that vary by state. This ensures that schools maintain access to Medicaid funding, which supports vital services such as physical therapy, speech therapy, and other special educationSpecial Education Instruction designed to meet the unique needs of a student with a disability, provided at no cost to parents, including specially designed instruction and related services.-related servicesRelated Services Support services (such as speech therapy, occupational therapy, or transportation) that are required to assist a child with a disability in benefiting from their educational program..
Although consent is typically a one-time requirement, best practices suggest revisiting it during the student’s annual IEP meeting. This is especially true with parents who previously declined. Often, refusals stem from misunderstandings about what consent entails.
Parents may misunderstand the following aspects of the consent process:
- Scope of Consent: Parents may think that giving consent allows the school to access all of their child’s records. In reality, the consent only applies to the services outlined in the child’s IEP and is limited to the health-related services provided through Medicaid.
- Impact on Medicaid Benefits: Some parents might worry that granting consent will affect their child’s Medicaid eligibility or benefits, which it does not.
- Confidentiality Concerns: Parents may fear that their child’s personal info will be shared with others, when in reality it only allows the release of information relevant to Medicaid billing and services to trusted Medicaid agencies.
- Frequency of Consent: Parents might assume they need to give consent repeatedly, but it’s typically a one-time process unless a change occurs in the child’s services or eligibility.
The IEP meeting provides a key opportunity to:
- Explain what parental consent means
- Clarify how it benefits both the student and the district
- Address the concerns or misconceptions listed above
Many schools ask for consent once but don’t follow up if parents decline. However, making it a routine part of annual discussions increases the likelihood of obtaining consent. This will help students continue to receive the services they need while maximizing Medicaid reimbursements for the district.
💡 Recommended reading: FERPA Consent for School-Based Medicaid: Balancing Educational Support and Privacy
2. Include All Students in Your Demographic Database to Capture Changing Medicaid Eligibility
To ensure your district maximizes Medicaid reimbursements, add all students—not just those currently eligible—to your student demographic database. This is crucial because:
- Medicaid eligibility can fluctuate – A student who isn’t eligible today may qualify later due to changes in household income or many other factors affecting Medicaid eligibility.
- Billable services can change – State plan amendments may expand the list of reimbursable services, making previously non-billable services eligible.
Since Medicaid reimbursements can be retroactive to the effective date of eligibility or service approval, limiting your database to only previously eligible students may cause your district to miss out on potential funding. By including all students, you create the broadest opportunity to capture new eligible students and services, ultimately maximizing reimbursement for the district.
3. Enter Every. Single. Service. (Not Just Medicaid-Eligible Ones)
To follow up on the previous point, it’s not just about who is eligible—it’s about what services are provided.
We can’t stress the importance of Medicaid-related documentation enough: record every service provided for every student, not just those currently Medicaid-eligible. This is not only for auditing purposes but for billing as well. Why? As the saying goes: “If it’s not written up, it didn’t happen!” Sure, it might take a little extra time upfront but trust us— it can save you a lot of auditing pain and reimbursement losses on the back end.
💡 Takeaway for school districts:
Keeping thorough records ensures you have everything you need, exactly when you need it. A little effort now can mean fewer headaches later!
4. Watch for Lapsed IEPs to Maximize Reimbursements
Every year, every special education student gets a new IEP with clear service start and end dates. If there’s a gap between one IEP and the next, you’re leaving reimbursement dollars on the table—and that’s money your district shouldn’t be missing out on.
To make sure you’re capturing full reimbursement and maximizing Medicaid funding, keep an eye out for any lapses between IEPs. Even a small gap can mean lost funding. Stay on top of those dates, and don’t let the clock run out on your reimbursements!
5. Ensure Referrals Are Processed on Time
Referrals are required for Medicaid services in almost every state, with some exceptions such as Arizona and Wisconsin. Depending on your state’s rules, referrals may need to be sent to physicians for signatures, and delays in this process can cause lapses in referral dates.
Here’s the kicker: Referrals are valid for a full year from the date of the physician’s signature, not from when they’re submitted. So, if your referral submission is late, it could mean fewer service days to claim for reimbursement. Make sure referrals are processed quickly and on time to avoid cutting your reimbursement window short!
6. Keep Service Providers’ Licenses and Enrollment Up to Date
Lapses in licenses or enrollment in the Medicaid program can create all sorts of turmoil and delays for your documented provider services and the associated Medicaid billing. That’s why it’s critical to ensure that all of your school’s providers maintain current licenses and up-to-date Medicaid enrollment.
A provider’s failure to recertify could potentially require them to go through the re-enrollment process, and that can cause even more delays and more lost reimbursements, ultimately affecting the number of service days a school can bill for. Stay on top of this to avoid unnecessary disruptions!
💡 Recommended reading: Avoiding Common Medicaid Billing Mistakes
💡 Recommended reading: How to Simplify School-Based Medicaid Billing with Software
7. Ensure Oversight Approvals Are Done Efficiently
For providers that require mentor oversight — such as an occupational therapy assistant — any services they provide must be signed off on by their supervising mentor. Delays in sign-off by mentors can prevent the mentees’ services from being claimed in a timely fashion and that, in turn, delays reimbursements. You can help keep the ball rolling by identifying and monitoring missing service signoffs. Once these claims are signed, you can then submit additional services, increasing reimbursements.
8. Drive Transportation Reimbursements with Timely Service Documentation
Schools can seek Medicaid reimbursement for transportation costs—but only on the days that students receive related services. So, if a student receives Occupational Therapy (OT), Physical Therapy (PT), or Speech services twice a week but is transported every day, you can only bill for the days they actually receive services.
When related service providers document timely Medicaid services, you can also bill for the transportation costs on those days. Don’t let transportation funding slip through the cracks! Though, note that not all states allow billing for transportation under their state plan. For example, in Georgia, transportation services are not included in the state plan, meaning they cannot be billed for Medicaid reimbursement.
Smart, Streamlined Billing means more Medicaid funding for your school!
By leveraging these eight best practices and implement the latest school Medicaid billing strategies for 2025, your school district can see billable Medicaid services increase and watch your Medicaid reimbursements grow, right along with your students’ opportunities. And if you need support to help recover costs associated with the services you provide, or software to streamline the process even further, we at Go Solutions can help you there, too.
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