School based Medicaid reimbursements can vary and fluctuate year to year. The Medicaid in Schools newsletter reports that last year (2015), Indiana’s total annual Medicaid reimbursements per public school district ranged from less than $100 to $975,000 for covered IEP-required direct medical services and from $4,000 to $172,000 for MAC activities.

Some factors that may affect IEP Services Reimbursements:

  • the number of Medicaidenrolled students in the district
  •  the extent to which parents have given the required written consent to release student data for Medicaid billing purposes
  • the number, frequency and types of covered services required per the Individualized Education Programs (IEPs) of the district’s Medicaid-enrolled Special Education students
  • how many district clinical staff meet the licensure, credential and other requirements to be Medicaid-qualified providers of covered IEP-required services
  • the number and location of the district’s medical professionals who qualify to perform clinical supervision as required to bill services furnished by Medicaid-qualified “mid-level” practitioners
  • the district’s capacity to record and maintain documentation to support its Medicaid claims for each type of covered IEPrequired service (for example, a district may have capacity to maintain the records required to document OT, PT and Nursing but lack capacity to maintain the records required to document specialized transportation services)

Some factors that may affect MAC Reimbursements:

  • the percent of Medicaidenrolled students per district
  • the number of school staff who routinely perform MAC activities and can be/are included in the statewide random moment time study to document time spent on such activities
  • the amount of state and local dollars the district expends for salary and benefits costs for staff who routinely perform MAC activities
  • the district’s indirect cost rate (if applicable)
  • the extent to which a district’s random moment time study participants submit timely, thorough and accurate time study responses whenever they are randomly surveyed

Read the Medicaid in Schools Full Newsletter