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Demystifying the Language in Medicaid. Sponsored by the IDEA Partnership with support of the Learning the Language Practice Group of the School Mental.

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Presentation on theme: "Demystifying the Language in Medicaid. Sponsored by the IDEA Partnership with support of the Learning the Language Practice Group of the School Mental."— Presentation transcript:

1 Demystifying the Language in Medicaid

2 Sponsored by the IDEA Partnership with support of the Learning the Language Practice Group of the School Mental Health Community of Practice

3 National Community of Practice (COP) on School Behavioral Health::  A network that bridges mental health & education  A mission of shared work & common messages  Multiple disciplines & perspectives represented  Partners include:  National: Federal agencies & organizations  State: TA centers, State teams  Local Partners: Family groups & individuals 3

4 Focus of Learning the Language COP  Cross-system shared work:  Translating policy to practice  Aligning goals across agencies  Developing common indicators  Collaborative training efforts  Collecting State and/or local examples  Deepening understanding of roles  Building relationships 4

5 Presenter: Rena Steyaert Montana Department of Public Health & Human Services Medicaid School Based Service Program Officer National Alliance for Medicaid in Education (NAME) President Elect 2014 406-444-4066

6 Learning Objectives Attendees will: Gain understanding of Medicaid services by recognizing associated language Develop knowledge about Medicaid and School medical services and their history Learn how to seek Mental Health services available in their school and community 6

7 Survey the Audience 1. How much do you know about Medicaid? 2. How much do you know about Medicaid in a School setting in regards to medical services including mental health services? 7

8 What is Medicaid? Medicaid is a federal-state matching program designed to help reimburse for health services for low-income individuals enacted in 1965 by Title XIX of Social Security Act Federal match must be at least 50%; state pays difference School Based Services have to include a Federal Medical Assistance Percentage (FMAP) Medicaid currently serves more than 62 million Americans, which includes approximately 46 million parents and children and 9 million elderly and disabled individuals. These numbers will increase when the Affordable Care Act is in full effect 8

9 What is Medicaid? (cont’d)  Each State has the authority and responsibility to further design and administer their Medicaid program— 52 different programs in US  Each state has a State Medicaid Plan which details client eligibility, services available, requirements for the providers of these services and the payment methodology the state uses for all services offered in the state by its Medicaid program. 9

10 Understandable Language  Medicaid is a national health insurance that is administered differently in all 52 states.  Its use in Schools is considered a sub-set of Medicaid covered services available to its clients  These services are mandatory for those clients eligible due to a Federal law that Schools and Medicaid have to abide by. 10

11 Common Assumptions All stakeholders agree:  All Children should have a quality education, regardless of abilities  Challenges should be addressed with maintaining respect  Classroom teachers need support in addressing mental health conditions and its impact on behavior and learning. 11

12 Why should Mental Health providers care?  Children spend the majority of their time in schools and some need help to focus on their school work.  Children may be in jeopardy of being suspended or kicked out of the school environment due to behaviors associated with their mental health condition and/or lack of treatment 12

13 Bridging Mental Health in Schools and Medicaid: Medicaid is one of the oldest avenues to gain reimbursement in a school for medical services including mental health services The next slides will demonstrate the emergence of Medicaid in Schools. 13

14 What is Confusing and Complicated?  Some schools don’t participate in Medicaid  Even schools that do participate don’t fully understand Medicaid  There is confusion and reluctance to accept a new service like Mental Health treatment and counseling in a School 14

15 Opportunities exist  Educate yourself about services in Schools and Private Practice  Advocate for your child  Work together in your community, school, and state to access services in schools Children need our help to stay in school so they can receive an education 15

16 Let’s Learn About Some Specific Medicaid-Related Language 16

17 EPSDT and Medicaid The Early and Periodic Screening, Diagnosis and Treatment program (EPSDT) was added to the Medicaid program in 1967 through amendments to the Title 19 of the Social Security Act 1965:  To provide well-child and comprehensive pediatric care for children up to 20 years of age.  Includes physical, mental, developmental, dental, hearing, vision & other screening tests to detect potential problems

18 IDEA and MCCA and Medicaid Individuals with Disabilities in Education Act (IDEA) was developed in 1986 as a result of moving children with disabilities into main stream school settings. In 1988, Congress enacted the Medicare Catastrophic Coverage Act, allowing state Medicaid programs to reimburse school districts for some health and related services in a child’s Individualized Education Program (IEP) The Medicaid program provides some reimbursement to schools for some related services received by children for special education as identified in their IEP Medicaid reimbursement has provided significant assistance to school districts who enroll with their State Medicaid Program— almost every state reimburses school districts 18

19 IDEA and Medicaid There are four conditions that must be met for Medicaid to reimburse school districts for IDEA related services: 1. The child receiving the service must be enrolled in Medicaid 2. The services must be covered in the state’s Medicaid plan or authorized by the federal statute 3. The service must be in the student’s IEP 4. The school must be enrolled/authorized by the state as a qualified Medicaid provider 19

20 Some Services Medicaid Reimburses Schools (or related services in IDEA law) Speech Therapy Occupational Therapy Physical Therapy Nursing Medicaid Evaluations Transportation Personal Care Vision and Hearing Assistive Technology Orientation and Mobility School Psychologist w\ appropriate school credentials 20






26 Types of Reimbursements 1. Fee for Service---used by some but not all programs. Reimbursement is made based on the actual type and degree of effort given to a service by a specific provider. 2. Cost Based method---used by others and involves a calculated method of paying for the service. ……Both are State Plan dependent. 26

27 Putting the Nuts and Bolts to Use……. Medicaid is a Health Insurance that reimburses for medically necessary services. Medicaid is administered in all 52 states by that individual states rules and State Plan that are overseen by the federal Center for Medicare and Medicaid services (CMS). 27

28 Putting the Nuts and Bolts to Use……. Medicaid is an option for reimbursement for school services for Medicaid eligible kids on IEPs that list these services as required for an education. Mental Health services may or may not be listed in an IEP. 28

29 Action Steps 29 Does the school participate in Medicaid Service claiming? YES Do they include mental health services in the IEP? No, find out if they can and would Yes, then find out how and whom they are doing that service with NO --- this could be the stopping point because the school chooses to participate and may not be familiar with claiming for Medical services done in their school.

30 Vignettes Does the audience have any general questions that we could help with? Remember that because Medicaid is administered in every state by it’s own state plan, that a state specific question will be best asked in your own community school and state Medicaid offices. 30

31 Wrap-up  To understand what is behind Medicaid being available in a school is the first step to “Learning the Language”.  Finding the correct resources in your community and state and being able to speak their language will eliminate confusion and delays.  Working towards implementing a service in your community is the goal. 31

32 Survey Question 1. Do you feel this webinar educated you and gave you some inspiration and direction to go in your community and state? 2. If no, do you have more questions? 32

33 33

34 Learning the Language Practice Group Scott Bloom, LCSW SBLOOM5@SCHOOLS.NYC.GOV Sandy Schefkind, MS, OTR/L SSCHEFKIND@AOTA.ORG

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