School Based Medicaid Services

MEDICAID Reimbursement

The goal of the Medicaid School Based Services program at the Monroe County ISD is to assist all districts in recovering as much of the cost of providing special education services to Medicaid eligible children as possible.

School Based Services is a program compromised of two components (1) Direct Service and (2) Administrative Outreach.  Monroe County participates in both of these programs.  Under Direct Service, Medicaid reimburses schools for health care services provided to Medicaid Eligible student in Special Education and/or Early On.  Under the Administrative Outreach Program, schools with staff who provide activities to assist the Michigan Department of Community Health (MDCH) in "finding" potential Medicaid eligible students, are reimbursed for the administrative costs associated with these activities.  

Medicaid billing and IEP service delivery will be documented in TIENET Service Capture. Please see the corresponding tip sheets for support in documenting your services accurately. 


 Video Document TIENET Service Capture Overview


Michigan Department of Health and Human Services (MDCH)- School Based Services Manual

 External LinkMedicaid Provider Manual

Supplemental MDCH Bulletins

The Administrative Outreach Program receives partial reimbursement for the administrative costs to identify and help students who are considered "at risk" for various health problems and direct them toward proper resources.

This program generates revenue by tracking the time spent on Outreach activities by school personnel, and by factoring the district's expense for staff providing these services.

School personnel chosen in the random moment sample are expected to complete their time study. Failure to do so affects the administrative portion of the state-wide reimbursement. 

The following school personnel may participate in the Outreach portion of the School Based Services program:

  • Audiologists

  • Speech Pathologists

  • Social Workers

  • Occupational Therapists

  • COTA's

  • Physical Therapists

  • PTA's

  • RNs and LPNs 

  • Psychologists

  • Psychiatrists

  • Orientation and Mobility Specialists

  • Teacher Consultants

  • Counselors

  • Early Identification/Intervention Personnel

  • Hearing Impaired Interpreters

  • Special Education Administrators

  • Program Specialists

Word DocumentAOP Information

Word DocumentAOP Non-Standard Job Information

Video DocumentMedicaid Reimbursement Overview

Targeted/Designated Case Management  (TCM) documentation for the Medicaid School Services Program is a unique responsibility. Where Direct Service providers document their direct service delivery as outlined in the IEP, and Personal Care Providers document their delivery of personal care services, TCMs document their coordination of care. The TCM documentation tells Medicaid how you ensure the students on your caseload have access to the services they receive in school and how they are progressing. Medicaid does not reimburse for academic support, as they are a medical payer. To further clarify and support your work in the program, please view the tip sheet, exemplars, and list of billable services provided. 

Video Document Targeted Case Management Service Capture

PDF DocumentTargeted Case Management

PDF DocumentExemplary Example - Designated/Targeted Case Management

PDF DocumentTypes of Billable Services for TCM

PDF DocumentTargeted Case Management - Detailed Presentation