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, Cost-Reports, and additional materials.
These are 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.
Early Periodic Screening, Diagnostic and Treatment (EPSDT)
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services- including in schools.
Learn more about EPSDT services and guidelines here.
Read an important informational bulletin concerning EPSDT here.
State Plan Amendments (SPAs)
SBS SPAs using a cost methodology and expanded services beyond IDEA to any Medicaid enrolled child:
- 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 expanded services for any child enrolled in Medicaid:
- Oregon SPA 19-0011. Approved May 18, 2023
SBS SPAs paying the regular Medicaid fee-schedule rate for certain services:
Expanded Services SPA:
- Nevada SPA 19-0005. Approved October 24, 2019
IDEA only SPA:
- Wyoming SPA 22-0001. Approved July 18, 2022
Time Study Implementation Plans
Cost-Reports
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.
Specialized Transportation in Schools
As a general rule, ordinary transportation of Medicaid beneficiaries to school is not covered by Medicaid because education is the primary purpose of attending school, even when a Medicaid-covered health service is provided in the school. However, Medicaid payment is available for transportation to onsite school-based services for children receiving services under the Individuals with Disabilities Education Act (IDEA). Read more…
New Medicaid Transportation Coverage Guide (see page 20 for coverage of School-Based Transportation)
School-Based Services Comprehensive Guide (see page 98 for coverage and reimbursement of School-Based Transportation)
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 Letter)
- School-based Health Services – HHS Resources March 2022
Additional Resources
CMS and the Department of Education are just two many organizations in the federal government offering assistance in providing resources to schools. Here are some additional links to programs that can assist schools in providing needed resources and information.
SAMHSA-
988 Suicide & Crisis Lifeline
988 Suicide Crisis Lifeline Partner Toolkit
HRSA – School-Based Health Alliance
School and Campus Health
The Substance Abuse and Mental Health Services Administration (SAMHSA) will work with State Medicaid Agencies and any school that wants to partner to expand the use of the 988 Suicide and Crisis Lifeline that is available to anyone that is experiencing suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress. To learn more about how to partner with SAMHSA or for more information, visit here.
HRSA & SAMHSA-
Advancing Comprehensive School Mental Health Systems
CDC-
School Health Services
Profiles 2020: School Health Profiles
Contact Us
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