To support State Medicaid agencies, LEAs, and school-based entities in providing and improving the delivery of covered Medicaid and Children’s Health Insurance Program (CHIP) services to enrolled students in school-based settings, CMS is providing links to sample State Plan Amendments, Time Study Implementation Plans, Administrative Claiming Plans, and Cost-Reports.
These are good examples of what a handful of States have done in implementing their school-based services programs. Some of these examples are older and may not be in full compliance with the latest CMS guidance from the 2023 Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.
State Plan Amendments (SPAs)
SBS SPAs using a cost methodology and opened “Free Care” services:
- Arizona SPA 21-0006. Approved October 25, 2021
- Colorado SPA 19-0021. Approved February 11, 2020
- Illinois SPA 21-0008. Approved April 18, 2023
- New Mexico SPA 22-0004. Approved May 18, 2023
SBS SPAs using a cost methodology and IDEA services:
- Utah SPA 21-0009. Approved August 15, 2022
SBS SPAs using a cost-based rate methodology and opened “Free Care” services:
- Oregon SPA 19-0011. Approved May 18, 2023
SBS SPAs paying the regular Medicaid fee-schedule rate for certain services:
Free Care SPAs:
- Nevada SPA 19-0005. Approved October 24, 2019
IDEA only SPAs:
- Wyoming SPA 22-0001. Approved July 18, 2022
Time Study Implementation Plans
Please contact us if you would like any technical assistance in developing your cost report.
Here are some State Medicaid Program links for Medicaid and School-Based Services (there are examples of provider manuals, cost reports, and other items that may be useful to other States):
- California DHCS Local Educational Agency Medi-Cal Billing Option Program
- Colorado State Department of Education School Health Services Program (Medicaid)
- New Hampshire Medicaid to Schools
Disclaimer: This United States Government website contains links to non-United States Government websites. We are providing these links because they contain additional information and resources relevant to the topic(s) discussed in this website on Medicaid and School-Based Services or that otherwise may be useful to the reader. We cannot attest to the accuracy of information provided on the cited third-party websites or any other linked third-party site. We are providing these links for reference only; linking to a non-United States Government website does not constitute an endorsement by CMS, HHS, or any of their employees of the sponsors or the information and/or any products presented on the website. Also, please be aware that the privacy protections generally provided by United States Government websites do not apply to third-party sites.
In addition to the linked examples here are links to policy papers and resources:
- CMS State Medicaid Director Letter, December 15, 2014. Medicaid Payment for Services Provided Without Charge (Free Care)
- School-based Health Services – HHS Resources March 2022
CMS is available to provide technical assistance to States to best implement their programs. If you have questions regarding implementation of these options, please contact CMS at: SchoolBasedServices@cms.hhs.gov