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What is the School-Based Medicaid Program?

The following information offers an overview of the program. For more information, see the SBMP Resource Center and the SBMP Program Guide.

The School-Based Medicaid Program (SBMP) offers local education agencies (LEAs) an opportunity to receive federal dollars to offset costs associated with providing certain Medicaid-covered services in a school setting. LEAs include cities and towns, charter schools, regional school districts, and vocational/technical schools.

MassHealth oversees the School-Based Medicaid Program, develops policies, and enforces compliance with state and federal laws and regulations. The University of Massachusetts Medical School (UMMS) administers the School-Based Medicaid Program on behalf of and in conjunction with MassHealth.

In order to seek reimbursement under the SBMP, LEAs must contract with MassHealth.  LEAs considering participating in the program may wish to review information in the Resource Center to learn more about the program or contact the School-Based Claiming Team. Ultimately, LEAs must reach out to the MassHealth Provider Enrollment Center to initiate the contracting process. For contact information see the SBMP contact information page.

Through June 30, 2019, direct services must be pursuant to an IEP to be reimbursable under the SBMP. Beginning July 1, 2019, the IEP requirement will be lifted and additional services and provider types will be added. This change is called Expansion. For more information about Expansion, please see SBMP Bulletin 31.

In preparation for Expansion, the SBMP will offer a series of trainings, frequently update the website, and post new documents in the SBMP Resource Center. Please continue to check the website for the most up-to-date information, and keep your LEA contact information up to date. The LEA Contact Information form is available in the SBMC Resource Center.

 

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