Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
As discussed in Section IV. C of the 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming, State Medicaid/CHIP agencies may share applicant and beneficiary information with schools enrolled as Medicaid or CHIP providers, or other Medicaid or CHIP providers, when the use or disclosure of the information is for purposes directly connected with the administration of the Medicaid or CHIP State plan, including establishing eligibility, providing services, or billing for services. Yes; An LEA or a school enrolled as a Medicaid or CHIP provider may receive beneficiary information on the condition that the school adheres to confidentiality standards comparable to those of the SMA or the State CHIP agency. The SMA and the State CHIP agency (in accordance with 42 C.F.R. § 457.1110(b)), as well as recipients of applicant and beneficiary information, must safeguard this information in accordance with the requirements of 42 C.F.R. part 431, subpart F confidentiality when they receive, use, or disclose applicant or beneficiary information.
One of these requirements is that the SMA or State CHIP agency must obtain permission from the individual, or their family, before responding to a request for information from an outside source, as set forth in 42 C.F.R. § 431.306(d). The Medicaid consent for billing purposes is separate from the FERPA and IDEA consent provisions.
The system used to identify Medicaid members is unique to each State. The Technical Assistance Center can help with research and work with States to identify best practices to address this issue. We recommend the SMA work with LEAs to develop an integrated system used by both entities.