Medicaid

Medicaid in Education

Medicaid is a state and federal partnership focused on funding health and medical services for enrolled beneficiaries. The Oregon Health Authority (OHA) is Oregon’s State Medicaid Agency and has the authority over, and administers, the School Based Health Services (SBHS) Medicaid program and associated rules and regulations. As the State Education Agency, the Oregon Department of Education (ODE) is primarily responsible for the State supervision of public elementary schools and secondary schools, and Early Intervention/Early Childhood Special Education (EI/ECSE) programs. In partnership with OHA, ODE provides support to school districts and programs for efficient and sustainable SBHS Medicaid billing, alignment of education systems and processes in schools, interpreting education rules and regulations, and navigating the crossover between health and education.

Oregon’s SBHS Medicaid program allows education agencies to enroll as a School Medical Provider (SM) and leverage Medicaid for reimbursement for eligible covered health services provided to Medicaid-enrolled children and young adults (ages birth-21). There are two types of SBHS Medicaid billing:

Medicaid Administrative Claiming (MAC): Provides reimbursement to education agencies for activities related to the administration of Medicaid. This includes activities such as referrals to medical or dental services, assisting a student/family in enrolling in the Oregon Health Plan, and coordination of Medicaid services.
Direct Services: Allows education agencies to seek reimbursement for covered health services provided by medically qualified staff. Direct service billing for ages birth to five Pre-Kindergarten is primarily performed by Early Intervention/Early Childhood Special Education (EI/ECSE) contractors and sub-contractors. Education agencies may also bill for direct services provided to children and young adults Kindergarten through age 21.