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Pennsylvania

SBAP reimburses local education agencies for eligible health services provided to students enrolled in Pennsylvania's Medical Assistance program. Districts that maximize reimbursement receive significant recurring funding that offsets the growing cost of special education.

Eligible services

Occupational Therapy ServicesSpeech and Language ServicesPersonal Care Services Counseling and Social Work ServicesNursing ServicesPhysical Therapy Services Psychological and Psychiatric ServicesPhysician ServicesOrientation, Mobility, and Vision Services Hearing and Audiology ServicesMedicaid Administrative Activities

Pennsylvania schools are leaving $75 million on the table each year

448Participating LEAs
$1,007Median reimbursement per billable student
250KStudents in LEAs not participating in the school-based Medicaid program
15%Of districts not participating in the school-based Medicaid program

Per capita distribution

There is an enormous gap in per capita reimbursement among Pennsylvania LEAs. We support school systems to move to the right side of this distribution.

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.

Our Pennsylvania K-12 school-based Medicaid services

We provide School-Based ACCESS Program implementation and analysis services to school systems throughout Pennsylvania. We are currently working with local education agencies in the Eastern, Central, and Western parts of Pennsylvania, including several of the largest LEAs in the commonwealth.

We are driving a shift in the role of the SBAP ACCESS Coordinator. Here is how we get there with your district.

FromData entry + process management
ToStrategic analytics + performance management

We marry our unique strategic analytics with a comprehensive approach to program coordination to ensure your district receives every dollar for which it is eligible.

Analyze

Medicaid Optimization Analysis

An in-depth review of your health services, health-related expenditures, and untapped reimbursement opportunities.

6 yearsof reimbursement data for every LEA in Pennsylvania, so we can benchmark your district against every other district in the state.

Coordinate

SBAP program coordination

We work with your business office, special education team, and other departments so every requirement has a clear owner and timeline.

  • Enrollment & reenrollment
  • Medicaid eligibility review
  • RMTS roster updates
  • Provider license verification
  • IEP compliance review
  • Medical authorization
  • Parental consent tracking
  • Admin activities reporting
  • Cost settlement reporting
  • Training & onboarding
  • ACCESS coordinator support
  • Provider eligibility checks
  • State policy change review
  • SBAP record keeping

Support

Technical assistance

Hands-on help in the SBAP areas where districts most often leave money behind.

  • Federal funds review Allocate IDEA funds so no reimbursement is lost
  • Record keeping systems Store and manage SBAP records efficiently
  • Medicaid outreach Reach families who may qualify
  • Performance tools Streamline your coordinator’s work
  • Transportation & depreciation Capture every eligible claim
Quarterly reports for school administrators, district leaders, and board members, so everyone works from transparent, quantifiable data toward one goal: every dollar your district is eligible for.
Tell us you're interested

Case studies

Two-page Wissahickon School District case study PDF

Wissahickon School District

A Montgomery County district reinvigorated its School-Based ACCESS Program and posted the highest year-over-year growth of any midsize LEA in Pennsylvania.

Download the case study (PDF)
Two-page Wilson School District case study PDF

Wilson School District

A Central Pennsylvania School District rebuilds its School-Based ACCESS Program from scratch and immediately sees tremendous revenue growth.

Download the case study (PDF)

The SBAPPY Awards

Each year we recognize the Pennsylvania districts leading the state in SBAP performance.

View the FY25 SBAPPY Awards

Request your performance profile

Each Pennsylvania LEA is benchmarked on the measures that drive reimbursement against all LEAs in the state that participate in the school-based ACCESS program. Your profile is free, and it is specific to your district.

Request your profile