School Medicaid
Administrative Claiming
How public education agencies can receive Medicaid reimbursement
for eligible administrative activities that support the Medicaid program
What is School Medicaid Administrative Claiming?
Administrative Claiming allows public schools and school districts to receive federal Medicaid reimbursement for certain administrative activities that support the Medicaid program. Allowable activities may include Medicaid outreach and enrollment assistance, referral and coordination of Medicaid covered services, certain transportation and translation activities, and Medicaid related training.
Unlike Direct Service Billing, Administrative Claiming does not reimburse schools for individual health services provided to students. Instead, schools identify the time employees spend performing allowable Medicaid administrative activities, typically through a time study. The results of the time study, together with applicable costs and allocation factors, are used to calculate the amount that may be claimed for Medicaid reimbursement.
Administrative Claiming operates within federal Medicaid requirements, but states establish the specific methodologies and procedures used by their programs subject to federal approval. As a result, allowable activity definitions, time study procedures, cost allocation methods, documentation requirements and claiming processes can differ from state to state.
THE KEY IDEA
Administrative Claiming does not reimburse schools for providing health services. It allows schools to recover a portion of the costs associated with performing allowable administrative activities that support the Medicaid program.
What School Activities Can Medicaid Administrative Claiming Reimburse?
The administrative activities eligible for Medicaid reimbursement vary by state. Depending on the state’s Administrative Claiming program, reimbursable activities may include:
Medicaid Outreach
Informing students and families about Medicaid and CHIP benefits, eligibility requirements and available covered services, and providing information about how and where to apply for coverage.
Access Support
Helping individuals access Medicaid covered services through activities such as arranging necessary transportation or providing eligible translation and interpretation assistance.
Eligibility Assistance
Helping students and families understand Medicaid and CHIP eligibility requirements, complete applications, gather necessary information and connect with appropriate enrollment resources.
Medicaid Related Training
Participating in or coordinating training related to Medicaid covered services, administrative requirements, referrals and the identification of students who may need access to covered services.
Referral & Coordination
Referring students to Medicaid covered services, coordinating access to needed care and following up to help ensure that students receive appropriate covered services.
Other Covered Services
States may authorize additional school based health services and provider types for Medicaid reimbursement beyond the categories listed here. What qualifies depends on the services, providers and requirements established under each state’s Medicaid program.
School Medicaid Administrative Claiming: Your Questions Answered
School Medicaid Administrative Claiming programs can vary significantly by state, but many of the same questions arise across programs. Explore some of the most common questions about allowable activities, time studies, costs, documentation and reimbursement below.
Schools may be able to claim costs associated with administrative activities that support the Medicaid program, such as Medicaid outreach, assisting individuals with Medicaid eligibility and enrollment, referring and coordinating access to Medicaid covered services, certain transportation and translation activities, program planning and coordination, and Medicaid related training. An activity is not reimbursable simply because it relates to student health. It must qualify as an allowable Medicaid administrative activity under the state’s approved Administrative Claiming program.