What does expanded access in schools mean?
Schools are an ideal setting for delivering health services since they have hours of direct contact with children each day. School-based services improve access to care while reducing burdens for families, particularly the need to take time off from work or school and transportation to and from appointments.
Medicaid also provides reimbursement to school districts for the administrative tasks associated with and in support of providing health services. Medicaid reimburses schools for outreach, facilitating Medicaid eligibility determinations, Medicaid-related training, and general administration.
School districts may bill for services that are included in children’s Individualized Education Plans or that are medically necessary through Expanded Access. Expanded Access was implemented in 2019 when the Kentucky Department for Medicaid Services submitted a State Plan Amendment to expand school-based Medicaid services to all children enrolled in Medicaid regardless of whether the child had an IEP.
Expanded Access Billing Instructions
To receive Medicaid reimbursement for the health service under Expanded Access, the service must be medically necessary, a covered service provided by a credentialed practitioner supplied to a child enrolled in Medicaid, and offered to all students and at no cost to the students.
Often the Expanded Access services are those Local Education Agencies (school districts) have provided for years without reimbursement.
Some services often provided in school settings include behavioral and physical health services, tests for flu or strep, and occupational, physical, and speech therapies.
The Department for Medicaid Services guides school districts on delivering health services in the Technical Assistance Guide. The guide is updated at a minimum annually and contains information such as definitions, documentation requirements, covered services, qualified providers, and billing guidance. Learn more about procedures and billing by
reading the Technical Assistance Guide.