Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Municipally Based Health Services Bulletin 14 April 2008 TO: Municipally Based Health Service Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Parental Authorization to Share Information with MassHealth Background Parents and guardians of students with Individual Education Plans (IEPs) have expressed concern that giving a school district permission to share information with MassHealth for the purpose of billing the Municipal Medicaid program will affect the MassHealth benefits that the students may receive. Clarification Claiming reimbursement through the Municipal Medicaid Program does not alter or reduce the benefits that students are entitled to receive from MassHealth. No Lifetime Caps Unlike many other insurers, MassHealth does not have a lifetime limitation or cap on the amount of services that a member may receive over the course of his or her enrollment in MassHealth. This means that if a member’s coverage type includes a service and if a member has an unmet medical need for that service, MassHealth will cover that service regardless of any services that member may have received in the past. Medically Necessary Services MassHealth pays only for medically necessary services in an amount sufficient to meet a member’s need. This means that, if a service is medically necessary for a student but the student’s school district provides the full amount of service that the student needs pursuant to an IEP, MassHealth will not pay for additional services of that same type because the student has no unmet need for the service. This is true whether a school participates in the Municipal Medicaid program or bills MassHealth for a given student. Therefore, giving a school district permission to share information with MassHealth for the purpose of billing the Municipal Medicaid program does not affect the student’s overall access to services. Questions If you have any questions about the information in this bulletin, please contact the University of Massachusetts Medical School at 1-508-856-7640, or e-mail your inquiry to Schoolbasedclaiming@umassmed.edu.