The endless forms and documents that build up when it comes to claiming expenses incurred from the services your district provides can really give you a headache. To investigate one company offering a simple software solution to this, click here.
If paperwork makes tears come to your eyes, these technological answers to an age-old problem will save you considerable time, stress, and expense. If the whole topic of claiming medical expenses makes your head spin, read more to consider the information regarding Medicaid payments, especially for school-based services.
What is Medicaid and Who Is it for?
Medicaid is a federal and state program available in the US that works to deal with the medical expenses of people with limited income and resources. It is the largest source of medical findings for people in this category in the whole of the United States, providing free health insurance for around 74 million people as of 2017. It is a means-tested program and is funded by both the state and federal government while being managed by the state. This means that each state has control over determining who is eligible for the cover and benefits provided by the program. Although participation by the state is optional, all states have been part of the program since 1982.
If you’re working in special education, it’s inevitable that you will have to deal with the paperwork surrounding Medicaid at some point. Therefore, it’s essential to fully understand what it can provide and why it is so valuable to public schools.
Medicaid for People with Disabilities
Medicaid is one of the four government-funded medical insurance programs currently running in the United States, but it is most likely the provider you will deal with when it comes to working in the field of special education. One in four beneficiaries of Medicaid is elderly people or people with disabilities.
Therefore, Medicaid spending is concentrated on these categories of enrollees. The coverage has changed over time and now has expanded; however, this expansion leaves many low-come families and children without affordable coverage. In order to fill gaps in private health insurance, some states can choose to provide Medicaid for children with significant disabilities in higher-income families too. Medicaid covers a broad range of services to meet the needs of the diverse population it serves. It provides comprehensive support for children in the form of EPSDT (Early Periodic Screening Diagnosis Treatment.)
This screening is essential for children with disabilities so that insurance policies can be adapted to meet their needs. Being under a policy with Medicaid greatly increases beneficiaries’ likelihood of going to the doctors and seeking treatment so they are less likely to endure an illness due to the cost of care.
Medicaid in Special Education
Special education and Medicaid have been linked for decades and through reimbursement, it has become a valuable asset to public schools. In fact, school-based Medicaid spending accounts for about $4.5 billion, out of the total Medicaid budget of $400 billion.
It’s a confusing topic and the protocols and paperwork that are involved can be mind boggling! With the rules and regulations constantly evolving, and the differences that occur between states administration of the program, it can feel hard to keep up. Recent reports of excessive and improper billing breed distrust and concern about the administration too. The news coverage of fraud and abuse within the Medicaid program has done a lot of damage to the reputation of the program.
There is a lot of information available to aid the understanding and navigation of these issues, and there are software systems available to make the processes a lot simpler and less stressful. Here are some commonly asked questions and the answers to help understand the jargon!
How do Schools Qualify to Gain Reimbursement for Services They Provide?
- The student must be 21 years of age or younger and Medicaid-eligible
- The services must be necessary, included in the student’s Individualised Education Program and provided by a credentialed professional
- The school district must be registered as a Medicaid provider and must follow the guidance on how to make claims of reimbursement
What Kinds of Expenditures Can be Reimbursed?
Direct Medical Services
Although it does depend on the guidelines of the state, things like nursing services, audiology, physical/occupational therapy, counselling, specialised transportation, and speech pathology, may qualify for reimbursement.
The administrative costs involved with special education can be extensive and wide-ranging so school districts can pursue reimbursement for these costs. Staff members must work hard in outreach efforts to inform students and families about the options available under Medicaid and to help them to apply for the various programs.
What Are the Misconceptions Surrounding Medicaid in Education?
- The school district will profit from the reimbursement.
Districts are required to insurer that the money used for the Medicaid covered services etc. is spent out of the available funding.
- If the school district bills Medicaid, it will have a negative impact on the student’s personal coverage.
This misconception has been disproven and the program is assured to provide free and appropriate public education without affecting a student’s personal Medicaid benefits.
- The stress of the reporting makes participation in Medicaid too difficult.
Every year, school districts claiming reimbursement from Medicaid must complete a cost report. This is a complete and comprehensive report of what has been spent on the medical services for the students under their care. The role of completing this form takes a lot of preparation, as the report must include a variety of figures from staff salaries to equipment costs. As with many paperwork jobs, technology has stepped in to make the process of data collection and entry a lot simpler.
A Solution for Now and for the Future
Modernized rules and regulations, improved oversight and management, innovative technology, and progress in compliance have greatly simplified the process and hopefully will maintain the viability and usefulness of the program for the foreseeable future.