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What is school-based Medicaid?

A school staff member working one-on-one with a smiling elementary student in a classroom.

School-based Medicaid programs in K-12 school systems reimburse school districts, charter schools, and other local education agencies for health services they provide to Medicaid-enrolled students — including speech therapy, occupational and physical therapy, nursing, counseling, social work, personal care services, specialized transportation, and more.

Covered services: speech therapy, occupational therapy, physical therapy, nursing, counseling, social work, personal care services, specialized transportation, and more.

School-Based Medicaid Reimbursement: What the Data Show

Medicaid Reimbursement Per Billable Student* FY25 $75M+ left on the table annually BOTTOM 3 QUARTILES VS. TOP QUARTILE 0 20 40 60 80 Number of Pennsylvania LEAs Top quartile 15 Less than $150 23 $150–$299 48 $300–$449 44 $450–$599 40 $600–$749 31 $750–$899 31 $900–$1,049 37 $1,050–$1,199 27 $1,200–$1,349 24 $1,350–$1,499 22 $1,500–$1,649 18 $1,650–$1,799 16 $1,800–$1,949 14 $1,950–$2,099 8 $2,100–$2,249 69 Over $2,250 Bottom 3 Quartiles (Under $1,800 per billable student) 12 ranges | 360 LEAs Top Quartile ($1,800+ per billable student) 4 ranges | 107 LEAs

*A billable student in this Pennsylvania context is defined as a student who has a Medicaid-eligible service in their IEP and is enrolled in Medicaid.

In every state, there is a wide range of performance related to School-Based Medicaid reimbursement. Some districts and charter schools are able to generate thousands of dollars per eligible student. Other districts and charters with similar student body profiles and similar special education expenditure levels generate only a fraction of that amount, resulting in hundreds of thousands of dollars — and sometimes millions of dollars — left on the table each year.

Pictured is a snapshot of the per capita Medicaid-reimbursement distribution of Pennsylvania local education agencies. The bottom three quartiles of LEAs are leaving over $75 million on the table annually relative to the top quartile.

Supporting Medicaid Reimbursement Performance Improvement

School-based Medicaid program implementation requires expert performance management systems and procedures in order to efficiently coordinate the many requirements.

At Mile 2 Consulting, we marry our unique strategic analytics and performance management tools with a comprehensive and detail-oriented approach to program coordination to ensure your district receives every dollar for which it is eligible.

Enrollment & eligibility Program Enrollment & Reenrollment Medicaid Eligibility Review Parental Consent Tracking Medical Authorization Medicaid Outreach Materials Providers & training RMTS Roster Development & Updates Provider License Verification Provider Eligibility Checks Provider Training & Onboarding Program Coordinator Training and Support Compliance & reporting IEP Review & Medicaid Compliance Guidance Administrative Activities Reporting Cost Settlement/Reconciliation Reporting Program Record Keeping Review of State Policy Changes

Our states

Each state runs its own program under its own name and rules. Select yours.

Pennsylvania

School-Based ACCESS Program (SBAP)

Medicaid Administrative Claiming (MAC)

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Announcing: the Pennsylvania awards for excellence in School-Based ACCESS Program Performance Yearly

The SBAPPY Awards

Click here to see the award winners

California

Local Educational Agency Medi-Cal Billing Option Program (LEA BOP)

School-Based Medi-Cal Administrative Activities (SMAA)

Children and Youth Behavioral Health Initiative (CYBHI)

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New York

School Supportive Health Services Program (SSHSP)

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Massachusetts

School-Based Medicaid Program — Direct Service Claiming (SBMP / DSC)

Administrative Activity Claiming (AAC)

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Illinois

School-Based Health Services (SBHS)

Medicaid Administrative Claiming (MAC)

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Texas

School Health and Related Services (SHARS)

Medicaid Administrative Claiming (MAC)

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Our impact

Real results, lasting impact: more Medicaid revenue, more support for students — up to 128% revenue increase in the first year, new programs launched from the ground up, and more resources for tens of thousands of students

Direct support

We have helped school systems quickly and dramatically increase their school-based Medicaid revenues by up to 128% in the first year! We have also helped numerous school systems launch new Medicaid billing programs from scratch. These success stories mean that our client schools are able to give tens of thousands of students with special needs access to significantly more resources and support.

A laptop showing a school-based Medicaid analytics dashboard with a U.S. map, trend and distribution charts, ringed by state outlines including California, Texas, Pennsylvania, Florida, New York, Illinois and Oregon

Research

We have developed the nation’s most comprehensive quantitative database of school-based Medicaid performance across dozens of states. We are able to provide unparalleled insights into the performance and the opportunities for school-based Medicaid services for school systems.