School Based Health Services
The foundation for the relationship between Medicaid and
education was established by the Medicare Catastrophic Coverage Act
(Public Law 100-360), as amended in 1988. Medicaid pays for costs
of direct, medically necessary services provided to eligible
children who have disabilities in accordance with the Individuals
with Disabilities Education Act (IDEA). Illinois has actively
supported this relationship since 1992, through the School-Based
Health Services program (SBHS). In Illinois, services that may be
claimed for School-Based Health Services'
These services are frequently specified as necessary related
services in individual education programs (IEP) developed by
schools for children with disabilities. When these services are
provided under a child's IEP, the services are eligible for federal
Medicaid reimbursement, usually half of the established cost to
provide the service.
Schools may also claim some costs for the administration of the
program, in addition to direct medical services. Allowable
administrative claims include outreach activities designed to
ensure that the entire student community has access to Medicaid
covered programs and services. Local Education Agencies (LEAs) may
claim costs for specific administrative activities, as well as
costs incurred for implementing and monitoring the Illinois state
Medicaid plan.
Services Provided
Medicaid reimbursement are:
- Audiology
- Developmental assessments
- Medical equipment
- Medical services
- Medical supplies
- Nursing services
- Occupational therapy
- Physical therapy
- Psychological services
- School health aide
- Social work
- Speech/language pathology
- Transportation