State Scrambles to Clarify Requirements for Medicaid to Schools

Oct 4, 2019

Credit Michael Brindley / NHPR

Gov. Chris Sununu and the New Hampshire Department of Health and Human Services are scrambling to help schools comply with Medicaid reimbursement rules to avoid massive fines from the federal government.

Schools can apply for partial reimbursement for health, substance abuse, and special education services provided to students eligible for Medicaid. About 90,000 youth under 18 are enrolled in Medicaid and would be eligible for services in schools.

But to get medicaid reimbursement for these services, the school must hire providers who have proper education credentials and who are enrolled with the state as a New Hampshire Medicaid provider.

An audit this summer found that many providers in schools don’t meet these requirements, which has led to improper reimbursements for years and could result in substantial fines. In a letter to superintendents this week, Department of Education Commissioner Frank Edelblut explained:

"A school psychologist or school counselor is not qualified to provide Medicaid reimbursable psychological services under the Medicaid State Plan. However, this is the type of reimbursement requested by our schools. These transactions jeopardize not only funding for the Medicaid to schools program, but also Medicaid programs across the state."

The state is in the process of developing new rules for the Medicaid to Schools program, which should clarify reimbursement eligibilty. Sununu says he is working with the Centers for Medicare and Medicaid Services and DHHS to ensure schools come into compliance and can continue getting reimbursement rather than pay for services in full.