Monday, August 4, 2014

Medicaid and Special Education Consent Form -- Should You Sign It?

Iowa parents frequently ask me if they should sign the consent form given to them by their child’s public school to give permission to the school district or AEA, to bill Medicaid for some of the services set out in the child’s IEP. 

I generally answer “No.”

Before school districts and AEAs request parental consent to bill Medicaid to pay for services set out in a child’s IEP, they are required by federal law to determine that all of the IDEA’s “no cost” requirements set out in 34 CFR §300.154(d)(2)(i)-(iii) are met. See 34 CFR §300.154(d)(2)(iii).  However, parents have told me that when they asked schools and AEAs, those agencies were unable or unwilling to respond in regard to whether school/AEA use of the child’s benefits might have any of the following effects :  
  • Decrease the available lifetime coverage or any other insured benefit (e.g., decrease the plan’s allowable number of mental health or physical therapy sessions available to the child);
  • Result in the parent being liable to pay for serices that would otherwise be covered by the  public benefits or insurance program because the child also requires those services outside of the time the child is in school;
  • Increase the premium or lead to cancellation of the public benefits or insurance; or
  • Cause the parent or child to risk the loss of their eligibility for home and community-based waivers based on total health-related expenditures.

The IDEA prohibits any use of a child's or parent's public benefits or insurance if it may have any of these effects. See 34 CFR §300.154(d)(2)(iii).

The IDEA regulations that govern school district and AEA use of a child' public benefits and insurance are addressed by the federal Department of Education Office of Special Education Programs (OSEP) in "Letter to McKinney." In that letter, OSEP explains that BEFORE a school district may bill Medicaid for school services, it must make a determination that school use of those benefits won’t violate the IDEA’s requirement that special education services must be “free.” It further explains that a school district or AEA may not require parents to sign up for, or enroll in Medicaid or any other public benefits or insurance program as a condition of the school/AEA’s provision of services to the child that the IDEA.

The "Letter" also explains that a school district or AEA may not require the parent to pay an out-of-pocket expense, such as the payment of a deductible or co-pay amount for filing a claim for services that the district is otherwise required to provide the child without charge.  For example, if a child’s IEP includes mental health counseling, and the parent’s or child’s insurance requires a $25 co-pay or deductible payment for a session, the school/AEA must to pay the cost of the co-pay or deductible if it bills the parent’s or child’s public benefits or insurance program for the particular service.

Good things to know.


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