School-Based Services FAQs

What is Medicaid?

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

What is the School-Based Services (SBS) Benefit?

The school-based services (SBS) benefit has been established according to s. 49.45(39), Wis. Stats. This benefit is designed to increase federal funding to Wisconsin schools to help pay for medically related special education and related services.

Is there a cost to me?

There is NO cost to you! You child is entitled to a Free and Appropriate Public Education (FAPE) under the Individuals with Disabilities Education Act (IDEA).

Do schools need parental consent to submit Medicaid claims?

Yes. Schools are required by the Family Educational Rights and Privacy Act (FERPA) to obtain parent consent before disclosing information about a student with a disability. This includes providing information to Medicaid. The school needs parental consent to help offset the costs of services.

Will my school bill my private insurance as well?

No.  Because there could be a cost incurred by the family, schools do not bill private insurance for IEP related services.

Will Medicaid services my family receives outside of school be affected?

No. Medicaid services received outside of school and school based service claims as part of the child’s plan of care (IEP) are authorized separately.

Does this process impact the school services my child will receive?

No. Although this partial reimbursement is available only for students who are Medicaid, BadgerCare, or ForwardHealth eligible, services are provided to all students with disabilities regardless of their eligibility status.

What can schools submit Medicaid claims for?

Schools can only submit claims for medically related services outlined in the student’s Individualized Education Plan (IEP). In general, claimable services for a school district include: attendant care services, nursing services, physical therapy, occupational therapy, speech and language pathology services, specialized medical transportation, psychological services, counseling, social work services, and developmental testing and assessment.

What are the requirements for the district to bill Direct Medical Services?

  • The child must be between the ages of 3 and 21, since the services are allowable under the federal EPSDT laws.
  • The child must be Medicaid eligible at the time of the service.
  • The child’s Individualized Education Program (IEP) must document the medical necessity (need) for the service.
  • The district must have a signed Parental Consent form if the district submits interim bills on behalf of the student.
  • The service must be delivered by an approved provider type.
  • The service must be properly documented.

How do schools use the money they receive from Medicaid?

Money that school districts receive is applied to that system’s general fund and can be used as that local school district determines.


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