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The School-Based Medicaid program allows local education authorities (LEAs), such as cities and towns, charter schools, public health commissions, and regional school districts, to seek payment for providing medically necessary Medicaid services (direct services) to eligible MassHealth-enrolled children. This program also allows such agencies to seek payment for participating in activities that support the administration of the state's Medicaid program (administrative activities). This would include outreach, and those activities that aid the delivery of direct services to Medicaid-enrolled children with individualized education plans (IEPs).
State law allows LEAs to participate in the Municipal Medicaid program and to seek payment for either direct services or administrative activities. In order to participate in the program, LEAs must sign provider contracts with the state Medicaid agency. Municipal Medicaid providers can bill MassHealth in accordance with the contract terms.
LEAs can receive payment for providing medically necessary Medicaid services to MassHealth-enrolled children who have an IEP. A child must have a current IEP in order for the LEA to be reimbursed through the Municipal Medicaid program. You can find details about the DSC program in the School-Based Medicaid Program User Guide.
LEAs can receive payment for participating in activities that support the administration of the state's Medicaid program such as outreach, and activities that aid the delivery of health-related services to Medicaid-enrolled children with IEPs. You can find details about the AAC program in the School-Based Medicaid Program User Guide.
More details about the direct service and administrative activities claiming programs are available in the School-Based Medicaid Publications section of the MassHealth Web site.