Alabama School Medicaid Snapshot
Expansion of School Medicaid Program
Alabama has not expanded its school Medicaid program beyond school health services documented in a student’s IEP or IFSP.
Coverage & Billing
Alabama covers the following school-based health services, when medically necessary for the development of the IEP or when fully documented in the IEP:
- Audiology Services
- Counseling Services*
- Occupational Therapy
- Physical Therapy
- Personal Care Services
- Speech/Language Services
- Nursing Services*
- Transportation Services
Eligibility: *Nursing Services and Behavioral Healthcare (“Counseling”) Services are covered for Medicaid-eligible children under age 21 who are eligible for EPSDT services and for whom the service is medically necessary; these services must be documented in the IEP/IFSP.
Billing: The billing providers are the LEAs. Individual rendering providers do not need to enroll in Medicaid for schools to bill. Alabama does not have managed care.
Reference Document: Alabama Provider Manual, Section 103
Nursing Services
Nursing services are defined as: The promotion of health, prevention of illness, and the care of ill, disabled and dying people through the provision of services essential to the restoration of health.
The types of providers eligible to provide the service for Medicaid reimbursement purposes include:
- Licensed Registered Nurse
- Licensed Practical Nurse
- Advanced Practice Nurse (APN)
- Nurse Practitioner
- Clinical Nurse Specialist (CNS)
- Licensed Vocational Nurses (LVN)
Services may include authorized delegation from APN, NP, or RN.
Reference Documents:
Alabama Provider Manual, Sections 103 (Intro) and 103.6.7
Standards of Nursing Practice as in Rule 610-X-6
Behavioral Health Services
Behavioral healthcare is covered as “Counseling Services” and may include:
- Testing and/or clinical observations
- Health and behavior interventions to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems (including, e.g., cognitive behavior modification, psychotherapy, etc.)
The types of providers eligible to provide the service for Medicaid reimbursement purposes include:
- Licensed Psychologist
- Licensed Psychological Associate
- Licensed Certified Social Worker
- Licensed Marriage and Familiy Therapist
- Licensed Professional Counselor
- Licensed Psychiatrist
- Registered Nurse (with a master’s degree in psychiatric nursing)
- Licensed School Psychologist
- Licensed Specialist in School Psychology
Reference Document: Alabama Provider Manual, Section 103
Research Methods & Limitations
The information provided in this analysis represents findings from a 50-state review of publicly available information, most of which was available online as of March 15, 2021. In general, state Medicaid programs require healthcare practitioners to be licensed or authorized in the state in which they are practicing, and services are typically limited to those within the practitioner’s scope of practice under state law. The review for this project did not account for changes that may have been made to Medicaid coverage in response to COVID-19. It also did not include information related to state Medicaid coverage for Applied Behavioral Analysis Therapy in school settings.
Contact your state’s Medicaid agency to verify specific program requirements related to reimbursement. State Medicaid requirements may change at any time, and the information in this document should not be considered as legal or compliance advice.
Prepared by Healthy Schools Campaign. For additional information, visit the School Medicaid Map.
