(1) A public agency may use the Medicaid or other public benefits or insurance programs in which a child participates to provide or pay for services required under this part, as permitted under the public benefits or insurance program, except as provided in paragraph (d)(2) of this section.

(2) With regard to services required to provide FAPE to an eligible child under this part, the public agency -

(i) May not require parents to sign up for or enroll in public benefits or insurance programs in order for their child to receive FAPE under Part B of the Act;

(ii) May not require parents to incur an out-of-pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim for services provided pursuant to this part, but pursuant to paragraph (g)(2) of this section, may pay the cost that the parents otherwise would be required to pay;

(iii) May not use a child's benefits under a public benefits or insurance program if that use would -

(A) Decrease available lifetime coverage or any other insured benefit;

(B) Result in the family paying for services that would otherwise be covered by the public benefits or insurance program and that are required for the child outside of the time the child is in school;

(C) Increase premiums or lead to the discontinuation of benefits or insurance; or

(D) Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures; and

(iv) Prior to accessing a child's or parent's public benefits or insurance for the first time, and after providing notification to the child's parents consistent with paragraph (d)(2)(v) of this section, must obtain written, parental consent that -

(A) Meets the requirements of § 99.30 of this title and § 300.622, which consent must specify the personally identifiable information that may be disclosed (e.g., records or information about the services that may be provided to a particular child), the purpose of the disclosure (e.g., billing for services under part 300), and the agency to which the disclosure may be made (e.g., the State's public benefits or insurance program (e.g., Medicaid)); and

(B) Specifies that the parent understands and agrees that the public agency may access the parent's or child's public benefits or insurance to pay for services under part 300.

(v) Prior to accessing a child's or parent's public benefits or insurance for the first time, and annually thereafter, must provide written notification, consistent with § 300.503(c), to the child's parents, that includes -

(A) A statement of the parental consent provisions in paragraphs (d)(2)(iv)(A) and (B) of this section;

(B) A statement of the “no cost” provisions in paragraphs (d)(2)(i) through (iii) of this section;

(C) A statement that the parents have the right under 34 CFR part 99 and part 300 to withdraw their consent to disclosure of their child's personally identifiable information to the agency responsible for the administration of the State's public benefits or insurance program (e.g., Medicaid) at any time; and

(D) A statement that the withdrawal of consent or refusal to provide consent under 34 CFR part 99 and part 300 to disclose personally identifiable information to the agency responsible for the administration of the State's public benefits or insurance program (e.g., Medicaid) does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents.

In order to streamline an easier form of communication, the following email address will continue to be utilized for all communication regarding Medicaid/SHARS

• shars@springisd.org

For any student who receives personal care services, and may be eligible for Medicaid, the district may speak to the parent about obtaining Medicaid consent in order to be reimbursed for services provided to the student. (More information is below in the During the ARD section.)  

• If the consent form has not been signed, or the boxes are not checked, services rendered will not be billable.
• Please make sure consents (especially New Transfer students) are scanned and emailed to shars@springisd.org.  The original copy stays with the ARD paperwork to be turned into the records room. 
• The parent does not need to know the student’s Medicaid number off hand in order to sign consent.

Verify that the PCS form (from esped) has been completed correctly for all students that demonstrate a medical need for one. The PCS box needs to be checked, as well as at least one of the reasons why PCS is needed:

• Physical limitations
• Medical limitations
• Behavioral limitations

IEP Clerks will print out Medicaid: One Time Medicaid Consent and Annual Notice of Medicaid Rights forms (from esped) for every student with a PCS every year in the parent’s native language.

“For students who receive personal care services, the district is able to request reimbursement through the federal SHARS program when given permission by the parent. The district’s reimbursement has no impact on funding available for services provided by outside agencies. There is a possibility of 3rd party liability (referred to as pay & chase), however, if you receive an Explanation of Benefits (EOB) for services provided by the school district, please reach out to our Related Service Coordinator immediately and he will assist in addressing the situation. Remember that as the parent, you have the right to revoke services at any time, for any reason. Has your child now, or has he ever been, eligible for Medicaid? Do you give the district permission to seek reimbursement for personal care services provided to your child through the federal SHARS program?”

1.   The Case-manager turns in all ARD paperwork with all original signatures (including Medicaid Consent Form) to the IEP Clerk.

2.   The IEP clerk scans a copy of the Medicaid Consent Form to shars@springisd.org 

3.   The SHARS Secretary will use the Medicaid Consent form to enter the information into esped on the Medicaid Information screen.

a.       Ensure the date is inputted correctly

b.       Check the box for eligible (yes) or refused (no)

c.       Input Medicaid number if it’s known (number is not required) 

4.   Annual notice will be the day consent is signed

5.   The IEP Clerk will archive the Medicaid Consent Form separately in esped under the name “Medicaid Consent.”

6.   The original document returns to ARD paperwork and gets sent to the administration building to be filed in the state folder with the 

      rest of the ARD paperwork.

Note

• If the parent did not attend the ARD via phone or in person, the case manager will call the parent and explain the SHARS program using something like the above example. After the case manager has explained the SHARS program to the parent and answered any questions, the Medicaid: One Time Medicaid Consent can be sent home to the parent to sign and return.

1. The DC/TL will enter the names (and required information) of each staff member on the line by position (put an asterisk (*) by names of new staff to your campus). 
2. If a new campus position or program has been added, type it below the gray line.  
3. If a position is vacant, please write the words "VACANT" in the staff member name box.
4. After you have filled in all the required boxes, electronically sign the form for the correct month.
5. The DC/TL will then share the form with the campus Principal to verify and sign electronically.
6. There is no need to print, scan, or email the form to anyone.

Yes, the child’s eligibility for Medicaid services outside the school setting is not compromised by receiving SHARS services at school. The services provided at school are so the child may receive a free and appropriate public education. Due to medical necessity, the child may need additional services outside of school. For example, a school may provide and bill for SHARS speech therapy for a student who also receives Medicaid THSteps-CCP speech therapy outside the school.  

There is no lifetime benefit cap for Medicaid services to children under 21. SHARS is a program under the EPSDT (Early and Periodic Screening, Diagnosis and Treatment) program. Under EPSDT, there are no set limitations on Medicaid services to clients under 21, so long as the service is medically necessary. The Medicaid services the child receives at school do not affect the type or amount of Medicaid services the child received outside of the school.  

Yes, Section 300.154(d) of the reauthorized IDEA 2004 requires districts to obtain informed parental consent. Schools should obtain informed parental consent to bill Medicaid for the specific services and the frequency as outlined in the child’s current ARD/IEP.