We are excited to partner with North Dakota schools to provide Medicaid-covered services to qualifying students in a school setting.
These services are for all Medicaid-eligible students whether they have an Individualized Education Plan (IEP) or not.
Many students are already receiving these services in schools. Billing Medicaid brings money back to your school so it can be used in other ways to benefit the health and well-being of your student body.
Services
These are some services a Medicaid-eligible child could receive in schools by a qualified practitioner.
- Physical Therapy
- Occupational Therapy
- Speech-Language Pathology
- Vision services
- Audiology
- Nursing services that support a child’s need to access free appropriate public education provided by a registered nurse for children with complex medical needs
- Applied behavioral analysis for children with autism spectrum disorder
- Transportation from school to IEP services provided at an offsite location and back to school
- Behavioral health services including rehabilitative mental health services
- Assessments
- Counseling and therapy
- Skills restoration and integration
- Medicaid 1915(i) State Plan Amendment home and community-based behavioral health supports**
- Vaccines
- Targeted case management (Serious Mental Illness/Serious Emotional Disturbance)
- Medical screenings and assessments, including Health Tracks screenings
- Counseling, social work, and psychology*
*School psychologists are not currently Medicaid-enrollable providers
**1915(i) supports are billed separately from IEP/IFSP and non-IEP/IFSP services
Rules for school-based services
Students must be:
- Medicaid-eligible on the date of service
Service providers must be:
- Enrolled with ND Medicaid and
- Employed by the school, or
- Contracted through the school
- Qualified/licensed to provide services within the scope of their practice.
Services must be:
- Covered under the ND Medicaid State Plan,
- Medically necessary,
- Provided directly to the student,
- Medical, not educational or instructional, and
- Billed under separate provider numbers for IEP, non-IEP and Medicaid 1915(i) services.
Some services may be delivered via telehealth. List of covered telehealth services. See Telehealth chapter in General Information for Providers Manual.
Differences between IEP and non-IEP services
Medicaid is funded jointly by state and federal governments. Each pays a certain percentage, known as a federal share and a state share.
State school aid payments are reduced by the state's share of IEP service reimbursement, aka Medicaid match. This match rate changes annually based on the Federal Matching Assistance Percentage.
| Topic | IEP | Non-IEP |
|---|---|---|
| Is ND Medicaid the primary payer? | Yes | Yes – Medicaid 1915(i) behavioral health support and services only No – Other non-IEP services are subject to 3rd party billing requirements (most common is private insurance). |
| Schools keep full service cost reimbursement | Schools are responsible to pay the state match, which is withheld from state aid payments. It’s never greater than 50%. | Yes |
| Medical documentation | Qualified services are authorized/prescribed in student’s IEP. Education plan is updated as eligible services start or stop. | Non-IEP and 1915(i) support and services are documented according to ND Medicaid service provider requirements. |
Upcoming learning opportunities
ND Medicaid will be hosting a series of webinars on school-based Medicaid. We invite school administrators, special education professionals, administrative staff, school board members and others who work with children in schools to attend.
Thursday, June 8 - 10 a.m. CDT
Topic: Medicaid 101
Learn about services, service requirements, student eligibility, who can provide services, differences between IEP and non-IEP services and more.
Recording of webinar
Thursday, Aug. 10 – 10 a.m. CDT
Topic: Nuts and Bolts of School Medicaid
Learn about enrollment, billing/claims and Medicaid-billable services.
Recording of webinar
Thursday, Sept. 28 – 10 a.m. CDT
Topic: Medicaid 1915(i) Services and Supports
Learn about eligibility, provider information and available services and supports.
Recording of webinar
For more information on school-based Medicaid services, contact Mandy Dendy at (701) 328-2427 or mrdendy@nd.gov.
If you have Medicaid claims or policy questions, contact the ND Medicaid Call Center toll-free (877) 328-7098, 711 (TTY) or mmisinfo@nd.gov.
Medical Services Division
North Dakota Health and Human Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Email: dhsmed@nd.gov
Phone: (701) 328-7068
Toll-Free: (800) 755-2604
Fax: (701) 328-1544
711 (TTY)