MEDICAID IN EDUCATION

Public schools may receive Medicaid funds for some health services provided to students at school. The services must be medically necessary and the student must be eligible for Medicaid and special education. In North Carolina, the following services may be reimbursed in schools:

• Audiology
• Nursing services
• Occupational therapy
• Physical therapy
• Psychological/counseling services
• Speech-language pathology services

NCDPI’s Exceptional Children Division provides Medicaid resource contacts:
Regions 1-4: Laurie Ray
Phone: 919.636.1827
Email: laurie_ray@med.unc.edu

Regions 5-8:
Lauren Holahan
Phone: 919.843.4466
Email: lauren_holahan@med.unc.edu

UPDATES/INFORMATION FROM DMA:

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The Exceptional Children Division continues to offer statewide support and guidance on public schools' access to Medicaid reimbursement. Please closely review the Medicaid bulletins, at http://www.dhhs.state.nc.us/dma/bulletin/index.htm.

The DMA in the North Carolina Department of Health and Human Services plans to implement post-payment reviews in order to ensure all policy requirements and medical necessity criteria are being met. While services provided by LEAs are excluded from prior authorization, these services are subject to post-payment review. Providers will provide documentation, via mail or fax, upon request. Overpayments will be recouped based on review findings in accordance with NC Medicaid policy 10C.

Please refer to the DMA bulletins for complete details and all information about these reviews that is available at this time. Also monitor our Medicaid webpage, as additional information about these reviews will be posted there as it becomes available. Contact Lauren Holahan at lauren_holahan@med.unc.edu or 919.843.4466 or Laurie Ray at laurie_ray@med.unc.edu or 919.636.1827 with any questions or comments.

Memo regarding: Revised NC Medicaid Notice of Privacy Practices
(pdf, 94kb)

EPSDT Policy Instructions Update
On August 17, 2007, the Division posted the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Policy Instructions Update. These instructions became effective September 01, 2007, and clarify the Division’s initial EPSDT Policy Instructions issued January 28, 2005. Please review the instructions carefully. Providers and case managers should communicate the information contained in the instructions to recipients under 21 years of age and/or their representatives. Children who have previously been denied or terminated from services may be eligible for additional Medicaid services if the services are medically necessary and if a request for services is made in accordance with Medicaid’s policies and procedures. The EPSDT Policy Instructions Update is located on the following website: http://www.ncdhhs.gov/dma/EPSDTprovider.htm

Instruction
(pdf, 247kb)