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What is the School-Based Medicaid Program (SBMP)?

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 for providing certain Medicaid-covered direct services in a school setting. This is referred to as the Direct Services Claiming (DSC) portion of the program. Additionally, the school setting provides a unique opportunity for local communities to partner with MassHealth (the Massachusetts Medicaid and Children’s Health Insurance Programs) to enroll eligible children in MassHealth, and to assist children who are already enrolled to access the benefits available to them. This is referred to as the Administrative Activity Claiming (AAC) portion of the program.

Covered types of direct care services in the SBMP include: Applied Behavior Analysis for members with Autism Spectrum Disorder (ASD), audiology, dental assessments/screenings, medical nutritional services, mental/behavioral health services, skilled nursing care, occupational therapy, physical therapy, physical and behavioral health screenings, and speech therapy.

In order to seek reimbursement in 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 Need Help with the SBMP?

The SBMP is separate from school-based health centers, which are offsite locations of hospitals and community health centers. Only LEA-incurred costs are reimbursable under the SBMP. The School Based Health Center Program is administered by the Department of Public Health and more information can be found here: https://www.mass.gov/school-based-health-centers-here-for-the-kids.

To continue learning about the SBMP, head to the Resource Center and read the "SBMP Program Guide for Local Education Authorities," or if you’d prefer to watch a video, head to the Training page and watch the SBMP 101 Introduction video (module 1).

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