SHARS/Medicaid Procedures


What's Required

(d)Children with disabilities who are covered by public benefits or insurance.
(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.

What We Do

Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as School Health and Related Services (SHARS). The oversight of SHARS is a cooperative effort between the Texas Education Agency (TEA) and Health and Human Services Commission (HHSC). SHARS allows local school districts to obtain Medicaid reimbursement for certain health-related services documented in a student's Individualized Education Program (IEP). 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 three of the following requirements. These students must:
  • Be Medicaid eligible,
  • Meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA), and
  • Have Individualized Education Program (IEP) 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, special transportation and personal care services.  These services must be provided by qualified professionals under contract with or employed by the school district. Furthermore, the school district must be enrolled as a Medicaid provider in order to bill Medicaid.


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

Guidelines for ARD/IEP Meetings

Medicaid Consent
If parent approves, please verify that Medicaid Consent form (from eSped) is signed, and that two the boxes above the parent signature are checked "yes".
    • If the consent form has not been signed, nor or the boxes 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. 
Note
  • The students medicaid number is not needed in order to scan consent.
  • When students turn 18 years old, please have the adult student sign a new Medicaid consent form.  

Personal Care Supplement (PCS)
Please verify that the PCS form has been completed correctly.  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

Before the ARD

IEP Clerks will print out Medicaid: One Time Medicaid Consent Forms for every student every year in the parent’s native language.


During the ARD
  • The Case-manager (or other Special Education staff member participating in the ARD) will ask the parent for consent at the end of the meeting after signatures are obtained.
  • They will explain that a district’s billing for Medicaid has no impact on a parent’s Medicaid benefits.
After the ARD


Monthly Medicaid Roster Procedure (Department Chair/Team Leader) 

The purpose of this form is to provide the required documentation regarding current campus staff allocations for special education services and Medicaid billing. 
  • Your campus form can be found at this LINK
  • This form is to be completed by the DC/TL by the 5th of each month
    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 Spring ISD). 
    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.

SHARS/Medicaid Frequently Asked Questions

1, If a child receives Medicaid billable services at school under the SHARS program, are they also able to receive the same service through Medicaid outside of the regular school hours?

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.  

2. Could billing SHARS cause a child to exceed any “cap” or lifetime maximum on their Medicaid benefits?

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.  

3. Is it required to obtain parental consent in order for the district to bill Medicaid under the SHARS program?

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.   

Additional Resources