Medicaid Consent and Notification
In 1988, an amendment to the Social Security Act provided statutory authority for SSHSP (School Supportive Health Services Program), also known as Medicaid in Education, by allowing Medicaid coverage of medical services included in the Individualized Education Programs (IEPs) of students with disabilities. The purpose of SSHSP is to provide Medicaid reimbursement to school districts for certain diagnostic and health support services provided to Medicaid-eligible students with disabilities. The SSHSP applies to students from age three years up to their 21st birthday.
Medicaid-reimbursable services under New York’s P/SSHS Program, for children with disabilities who are eligible for Medicaid, include:
- Physical therapy services
- Occupational therapy services
- Speech therapy services
- Psychological evaluations
- Psychological counseling
- Skilled nursing services
- Medical evaluations
- Medical specialist evaluations
- Audiological evaluations
- Special transportation services
In order to be reimbursable under the Medicaid program, school supportive health services must be:
- Medically necessary and included in a Medicaid covered service category;
- Included in the State’s Medicaid plan and/or available under Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to children up to age 21;
- Prescribed, ordered or referred by a practitioner acting within his or her scope of practice;
- Included in the child’s Individualized Education Program (IEP);
- Provided by qualified professionals under contract with or employed by a school district, and;
- Furnished in accordance with all requirements of the State Medicaid Program and other pertinent state and federal laws and regulations, including those regarding provider qualifications, comparability of services, freedom of choice and the amount, duration and scope provisions.
Parents/Guardians will receive two (2) forms for their student concerning Medicaid.
- Prior to obtaining consent for the first time, and once a year thereafter, the District will provide parents with a written notification that ensures that they are fully informed of their rights before a public agency can access public benefits or insurance to pay for services under the Individuals with Disabilities Education Act. This notice must be provided in the native language of the parent or other mode of communication used by the parent, unless it is clearly not feasible to do so. This notice is sent out yearly, around July 1st. It does not need to be returned to the District.
- This District will send out a form to obtain a one-time written consent from the parent before accessing the child’s or parent’s public benefits or insurance for the first time, including checking with the New York State Department of Health for a child’s Client Identification Number or for whether a child has Medicaid coverage. This consent is between the District and the State and is compliant with both FERPA and HIPAA. This consent must be returned to the District. Please do not send copies of insurance cards or other Personally Identifiable Information (PII). The District only requires the signature of the parent/guardian, and the CIN number, if available.