California School Medicaid Snapshot
Expansion of School Medicaid Program
California expanded its school Medicaid program to include all medically necessary services delivered to all Medicaid-enrolled students.
Coverage & Billing
California covers the following school-based health services:
- Health and Mental Health Evaluation or Education
- Audiology Services
- Nursing Services
- Nutrition Services
- Occupational Therapy
- Physical Therapy
- Speech Therapy
- Optometry Services
- Orientation and Mobility
- Physician Services
- Psychology and Counseling
- Respiratory Care
- School Health Aide
- Targeted Case Management
Eligibility: Medicaid-eligible children for covered medically necessary services.
Billing: The billing providers are the Local Education Agencies (LEAs), including school districts, county offices of education, charter schools, community colleges and university campuses. Individual rendering providers are not required to enroll in Medicaid to bill, and LEAs are required to ensure that only qualified rendering providers are providing services. School-based services are included in Medicaid managed care, and LEAs may contract with managed healthcare providers to render healthcare services separate and distinct from LEA services if mutually agreeable terms can be reached that do not create additional costs for the state or duplication of services. Payments are not capitated to the managed care entities.
Nursing services are covered as:
- IEP/IFSP health assessments
- Non-IEP/IFSP health nutrition assessments, health education, guidance, and vision assessments
- School health aide treatments including but not limited to gastric tube feeding, suctioning, oxygen administration, catheterization, and nebulizer treatment
Providers eligible for reimbursement:
- Licensed Registered Credentialed School Nurse (licensed by California Board of Registered Nursing with school nurse credential)
- Licensed Registered Nurse
- Certified Public Health Nurse
- Certified Nurse Practitioner
- Licensed Vocational Nurse (licensed by California Board of Vocational Nursing and Psychiatric Technicians and supervised by a Licensed Physician, Registered Credentialed School Nurse or Certified Public Health Nurse)
- Trained Healthcare Aide (must be supervised by licensed physician, registered credentialed school nurse, or certified public health nurse)
Reference Documents: California Local Education Agency Medicaid Provider Manual
Behavioral Health Services
Behavioral healthcare is covered as follows, depending on whether IEP/IFSP or non-IEP/IFSP student:
- Psychological assessment
- Psychosocial status assessments
- Health education & anticipatory guidance
- Psychology and counseling
Providers eligible for reimbursement:
- Credentialed School Counselor with pupil personnel services (PPS) credential and specialization in school counseling, or a valid statutory exception
- Credentialed School Psychologist with PPS credential with specialization in school psychology, or a valid statutory exception
- Credentialed School Social Worker with PPS credential with specialization in school social work, or a valid statutory exception
- Licensed Clinical Social Worker (licensed by the California Board of Behavioral Sciences) with PPS credential & specialization in school social work, a health services credential, or valid statutory exception, or supervised by PPS-credential holder
- Licensed Educational Psychologist (licensed by the California Board of Behavioral Sciences) with PPS credential & specialization in school psychology, or valid statutory exception, or supervised by PPS credential holder
- Licensed Marriage and Family Therapist (licensed by the California Board of Behavioral Sciences) with PPS credential, authorization, or a valid statutory exception, or supervised by a PPS-credential holder
- Licensed Physician (licensed by Medical or Osteopathic Medical Boards of California)
- Licensed Physician Assistant (licensed to practice by the California Physician Assistant Board) working under a valid written practice agreement under the supervision of a licensed physician
- Licensed Psychologist (licensed by the California Board of Psychology) with PPS credential and specialization in school psychology, a health services credential, or a valid statutory exception, or supervised by a PPS-credential holder
- Registered Associate Clinical Social Worker (registered with the California Board of Behavioral Sciences) supervised by a LCSW, LMFT, LPC, Licensed Clinical Psychologist, Licensed Physician certified in Psychiatry by American Board of Psychiatry and Neurology
- Associate Marriage and Family Therapist (registered with the California Board of Behavioral Sciences) supervised by a LMFT, LCSW, LPC, Licensed Psychologist, or a Licensed Physician/Surgeon certified in psychiatry by American Board of Psychiatry and Neurology
- Registered Credentialed School Nurse
Special requirements exist for contracted professionals (licensed by California Board of Registered Nursing with school nurse credential).
Reference Document: California Local Education Agency Medicaid Provider Manual
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.