Virginia Department of Medical Assistance Services (DMAS)
and
Virginia Department of Education (DOE)
Medicaid and Schools
The Arc of Virginia Annual
Convention
August 11, 2011
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Medicare Catastrophic Coverage
Act of 1988
Medicaid funds could be used to pay for
health-related services provided under
Individuals with Disabilities Education
Act (IDEA).
 Provided by a participating Medicaid provider
 Medically necessary
 Included in the state's Medicaid plan
 Provided to an individual eligible for Medicaid
 Screened for any other third party payment
that may be available for reimbursement.
Virginia: Medicaid and Schools
 1991 – DMAS began covering some
health related services in schools due to
requirement from the Governor’s Child
Health Task Force
 The 2002 Virginia General Assembly
directed DMAS to maximize federal
reimbursement for services, by working
with numerous organizations including
Local Education Agencies (LEAs).
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Virginia: Medicaid and Schools
2011 - Health related services have
expanded over the years for which schools
may receive reimbursement for children
enrolled in Medicaid, FAMIS or FAMIS Plus.
 These services must be provided by school
division employees, contracted employees, or
contracted agencies.
Virginia: Medicaid and Schools
Services include:
 Physical Therapy
 Nursing
 Occupational Therapy
 Personal Care
 Speech-Language
Therapy
 Medical Evaluations
 Audiology
 Specialized
Transportation
 Psychiatric,
Psychology and Mental
Health
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Virginia: Medicaid and Schools
The following services/administrative
duties are for both general education and
special education students
 Early Periodic Screening, Diagnosis and
Treatment (EPSDT)
 Administrative Claiming
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Federal and State Match Rates
Public schools may receive federal
Medicaid and CHIP reimbursement that
must be matched by state and/or local
dollars.
Federal Match rate for Administrative
Claiming is 50% - Virginia DMAS keeps
half of federal share
Federal Match Rate for Medicaid is 50%
Federal Match Rate for Medicaid Expansion
and FAMIS is 65%
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Provider Requirements
Services must be specified in the child’s
IEP
Current license on file with DOE for each
service practitioner
Signed Provider Agreement with DMAS
Signed Business Associates Agreement
with DMAS
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Business Associates Agreement
 To ensure privacy and security of
protected health information (PHI)
 Individually identifiable information, including
demographics, which relates to a person's
health, health care, or payment for health
care as specified in
45 CFR § 160.103 of the Final HIPAA Privacy
Rule.
 Virginia public schools shall not use PHI
otherwise than as expressly permitted by
the Agreement, or as required by law.
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Provider Requirements
Special Education and FERPA
 Obtain parental permission for billing public
insurance
DMAS Agency Director’s Letter to Parents
 Assures that by giving school permission to bill
public insurance does not impact services their
child receives by non-school providers nor
does it impact the service limits their child is
eligible for.
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DMAS website:
dmasva.dmas.virginia.gov
Medicaid
and
Schools
Find Provider Manuals and Memos at this link to the Medicaid Web Portal.
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DOE website:
www.doe.virginia.gov
Medicaid
and
Schools
Contact Information
DOE
 Amy Edwards, 804-692-0150
amy.edwards@doe.virginia.gov
DMAS
 Ashley Barton, 804-371-7824
ashley.barton@dmas.virginia.gov
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