U.S. flag

An official website of the United States government

In situations beyond IEP/IFSP (for children that do NOT have an IEP/IFSP), is Medicaid still

Yes, under Medicaid law and regulations, Medicaid is generally the payer of last resort for school-based services for enrolled students who might also have commercial insurance coverage, a tort settlement, or other third-party resource. Congress intended that Medicaid, as a public assistance program, pay for health care only after a beneficiary’s other health care resources have been exhausted. However, there may be exceptions to the requirement to pursue TPL reimbursement (see Social Security Act § 1902(a)(25), Social Security Act § 1902(a)(25)(a), and 42 C.F.R. § 433.136).

Date
FAQ ID
166446
FAQ Question
In situations beyond IEP/IFSP (for children that do NOT have an IEP/IFSP), is Medicaid still the last-resort payer for school-based services when enrolled students have commercial insurance, a tort settlement, or other third-party resources?