As specified in section 1905(r)(5) of the Act, the EPSDT benefit entitles most eligible Medicaid-enrolled children and adolescents to services and treatments that fit within any of the benefit categories of Medicaid-coverable services listed in section 1905(a) of the Act if medically necessary, as determined by the State, to “correct or ameliorate” identified conditions. A formal diagnosis is not required according to Federal Medicaid rules. State Medicaid agencies determine medical necessity criteria.

States generally have broad flexibility to identify the providers of a covered Medicaid service, including their qualifications, although specific federal provider qualifications do apply for certain services. 

States with Medicaid MCPs may have one of two arrangements to pay for school-based services. 

Each State’s approach to expanding SBS can vary depending on factors such as which services are being expanded and the source of funding. While there are many different types of managed care arrangements, State Medicaid agencies (SMAs) have flexibility in determining how services are provided. SMAs may elect to deliver some services through managed care plans (MCPs) and other services through an FFS delivery system; in fact, the majority of States do not include SBS in managed care and cover them under an FFS delivery system.

Examples of child find activities can include: 
For preschool- and school-aged children: Public awareness campaigns by the LEA or in partnership with a school’s parent teacher association that include information provided in languages spoken in the community and that target a wide audience, including parents and families, daycare and early childhood education providers, summer camps, medical providers, homeless shelters, religious institutions, and kindergarten roundup (i.e., events hosted by elementary schools to facilitate a child’s transition from home to formal education).

The 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming (p. 15) has language that states that “coverable services also include child find evaluations and reevaluations.” Medicaid may cover child find screening, evaluations, and reevaluations in certain circumstances (see FAQ on Child Find Activities).

Yes, some child find activities could be covered in Medicaid. Child find activities may involve a formal screening process to determine whether the child should be referred for an evaluation to determine whether a child has a disability and the nature and extent of the special education and related services that the child needs. In a scenario where a child is enrolled in Medicaid, a screening or initial evaluation could be coverable under a 1905(a) benefit category.

IDEA child find requires States to ensure that all children with disabilities residing in the State who need special education and related services are identified, located, and evaluated, regardless of the severity of the disability, and includes identification of children who are suspected of having a disability.

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, under both IDEA and FERPA, a public agency may accept digital or electronic signatures when obtaining parental consent to disclose PII from the child’s educational records. Such electronic consent must: 1) identify and authenticate a particular person as the source of the electronic consent; and 2) indicate such person’s approval of the information contained in the electronic consent.