Medicaid reimbursed SBHS provided to a Medicaid-eligible child must be deemed “necessary and appropriate” as defined in SBHS rules; recommended by a physician or other licensed healthcare practitioner within the scope of practice under state law for the treatment provided; specified in the child’s Individual Education Program/Plan (IEP), or the Individualized Family Service Plan (IFSP) addressing the physical or mental disabilities of the child; and provided by medically qualified staff.

Medicaid may reimburse costs for necessary and appropriate health services, on a fee for service basis, provided to Oregon’s Medicaid-eligible children who have disabilities, in accordance with the Individuals with Disabilities Education Act (IDEA).  Oregon has actively supported this relationship since 1992.  School Based Health Services that may be claimed for Medicaid reimbursement on a fee for service basis are:

• Audiology 
• Social work and psychological services  
• Nursing services  
• Occupational therapy     
• Physical therapy  
• Speech/language pathology
• Transportation 

In addition to SBHS provided on a fee for service basis, publicly funded education agencies may claim costs for:

• Medicaid Administrative Claiming (MAC) outreach activities designed to ensure that children in schools and the community have access to Medicaid programs and services; and
• Targeted Case Management (TCM) activities that assist individuals under Oregon’s State Plan in gaining access to needed medical, social, education, and other Medicaid covered services.

Important information and rules regarding participation in reimbursed Medicaid services provided in an education setting under the Division of Medical Assistance Programs (DMAP) is available on the SBHS Information Page  or you are welcome to contact us by email or by calling (503) 945-6730