School-Based Medicaid Programs
School Health and Related Services (SHARS) and the Medicaid Administrative Claiming Project (MAC) Medicaid programs are administered by the Texas Health and Human Services Commission (HHSC). SHARS allows local school districts to obtain Medicaid reimbursement for certain health-related services provided directly to children enrolled in special education, while the MAC program allows reimbursement for certain outreach and case management activities.
School Health and Related Services (SHARS) is a Medicaid financing program and is a joint program of the Texas Education Agency and the Texas Health and Human Services Commission (HHSC). SHARS allows local school districts to obtain Medicaid reimbursement for certain health-related services provided to students in special education. Using existing state and local funds as the state match, SHARS providers are reimbursed the federal share of the established reimbursement rate.
School districts receive federal Medicaid money for SHARS services provided to students who meet all four of the following requirements. These students must:
- be Medicaid eligible;
- be under 21 years of age;
- meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA); and
- have Individual Educational Plans (IEPs) that prescribe the needed services.
Current SHARS services include: assessment, audiology, counseling, school health services, medical services, occupational therapy, physical therapy, psychological services, speech therapy, person care services, and special transportation. These services must be provided by qualified staff under contract with or employed by the school district/ssa. Furthermore, the school district must be enrolled as Medicaid providers in order to bill Medicaid.
WHAT IS MEDICAID ADMINISTRATIVE CLAIMING?
The Medicaid Administrative Claiming Project (MAC) provides school districts with the ability to receive reimbursement for certain outreach and case management activities. The district can be reimbursed for certain medical and health-related outreach services delivered to all students within the district, regardless of whether the student is Medicaid eligible or not, and without any impact on other similar services the student may receive outside the district. The outreach services may be to a student or their family and for activities that include coordinating, referring, or assisting the student/family in accessing needed medical/health or mental care services. Revenue generated from MAC is dedicated to the provision of health services and may be used to enhance, improve and/or expand the level and quality of health/medical services provided to all students within the district.
HOW IS THE REIMBURSEMENT DETERMINED?
School districts can identify staff who perform the allowable administrative activities for some part of their work day. These staff will then participate in a Random Moment Time Study so that the portion of their time that can be claimed as Medicaid administration can be properly allocated.
WHAT TYPE OF ACTIVITIES ARE CONSIDERED "OUTREACH/CASE MANAGEMENT"?
A variety of personnel in local districts currently provide many health-related activities on behalf of their students. For example, a Student Assistance Program may provide comprehensive case management programs for high-risk students. Special education programs perform routine case management and case coordination functions for special education students and coordinate the delivery of related services.
District personnel may be asked to provide families with health-related information about their child’s growth and development or what to expect in caring for a student with disabilities or students with developmental delays. As part of the ongoing case management function performed in the schools, staff may assist families in arranging transportation to take a child to a medical appointment.
Speech, occupational and physical therapists may provide information to parents and other staff about specific health conditions or services to help such conditions. School staff may provide information to students and their parents about the risk of drug and alcohol usage and the signs of abuse or dependency.
School nurses, along with special education personnel are often the first to identify suspected health problems in children and to refer them for diagnosis, treatment of follow-up health, mental health, or substance abuse services. When ongoing health services are necessary and need to be provided in the school setting, school staff are in a position to assist children in appropriately following their health care plans. School nurses may monitor and provide training to aides who perform health procedures.
School nurses who maintain the school health clinic/office may discover that families of sick children do not have health insurance. Referrals are made to Medicaid when it is suspected that a family may be eligible. Other staff, especially those in special education, may facilitate SSI applications for special needs students.
School psychologists or counselors commonly do crisis intervention in schools. They may perform case management activities with families to ensure the child’s access to mental health or substance abuse treatment services. Staff may be required to assist an injured child in getting immediate medical attention.