The Medicaid Recovery Office was established to maximize recovery of Medicaid funds to offset the cost of special education for Medicaid-eligible students within the school district.
Medicaid is a federal-state program that provides health insurance to millions of low-income families and individuals. It is a means-tested program that is jointly funded by the states and federal governments, but managed by each state. Within the State of Maryland, the Maryland State Department of Health and Human Services ("DHMH") is designated as the Single State Agency to administer all aspects of Maryland Medical Assistance Programs.
Although this federal-state reimbursement is available only for students who are Medicaid eligible, services are provided to ALL students with special needs regardless of their Medicaid eligibility status.
Where Do the Medicaid Funds Go?
The Medicaid funds are used to offset health care and Special Education services currently provided by the school district. Health related services that are reimbursable from Medicaid are identified in a student's Individualized Education Program (IEP) or Individual Family Service Plan (IFSP).
What Services Do We Bill for?
school district can bill Medicaid for health related services identified in a
student's Individualized Education Program (IEP) or Individual Family Service
Plan (IFSP). These services include speech/language therapy, occupational
therapy, physical therapy, nursing, audiology, social work, counseling and
psychological services and evaluations. The school system is also allowed to
bill Medicaid for case management and transportation services for Medicaid
eligible students with IEPs.
The History of Medicaid Program within the School System
On July 1, 1988, President Ronald Reagan signed Public Law PL 100-360, the Medicare Catastrophic Coverage Act. This law permits local education agencies to recover costs from public health insurance for services identified in a child's Individualized Education Program (IEP). These services include speech/language therapy, audiology, occupational therapy, physical therapy, nursing, social work, psychological services and evaluations. Additionally, local education agencies are allowed to submit claims for IEP coordination services (case management) as well as specialized transportation services for Medicaid eligible students with special needs.
The Federal Government and the United States Congress have encouraged school systems to use all available federal funding, including Medical Assistance to finance special education and health related services.
As a result, in 1994, Prince George's County Public Schools began a system-wide effort to recover costs for health related and IEP coordination services for Medicaid eligible students. Currently, there are over 5,360 Medicaid eligible students with special needs in the Prince George's County Public School system. These students constitute 35% of the Special Education population and 4% of all students attending Prince George's County Public Schools. Medicaid reimbursement funds support and expand existing programs and provide funding for staff, specialized supplies and equipment that enhance the learning experience for all students with special needs.