Arizona School Medicaid Snapshot

Expansion of School Medicaid Program
Arizona expanded its school Medicaid program to include all medically necessary services delivered to all Medicaid-enrolled students.

The second state plan amendment describes the methods and standards for reimbursing school-based health and related services:

Coverage & Billing
Arizona covers the following school-based health services identified in the IEP:

  • Assessment, Diagnosis, Evaluation
  • Outpatient Services
  • Speech Therapy
  • Physical Therapy
  • Occupational Therapy
  • Nursing Services
  • Transportation
  • Behavioral Health Services
  • Audiology
  • Medical and Remedial Services
  • Optometry
  • Home Health Services

Eligibility: Medicaid-eligible children ages 3 to 21 who have been determined eligible for special education services under IDEA, Part B, pursuant to an IEP.

Billing: The billing providers are the Local Education Agencies (LEAs), including public school districts, charter schools not sponsored by a school district and the State School for the Deaf and Blind. Rendering providers must enroll in Medicaid. School-based services are carved out of managed care contracts.

Reference Documents: AHCCCS Medical Policy Manual, Chapter 700, Section 710

Nursing Services

Nursing services are covered as (but are not necessarily limited to):

  • Medical interventions such as medication administration, G-Tube feeding, etc.

Nursing services must be provided in accordance with student’s IEP and must be medically necessary to enable students to receive education in the public setting.

Providers eligible for Medicaid reimbursement include:

  • Licensed Registered Nurse under Arizona Revised Statutes (ARS) 32-1601 or the regulatory state body where nurse resides
  • Licensed Practical Nurse under ARS 32-1601 or the regulatory state body where nurse resides
  • School-Based Health Aides (covered as Assistance with Activities of Daily Living)

School-Based Health Aides must be trained and approved by schools in general care; must be identified in IEP, supervised by nurse or appropriate licensed personnel employed by, or contracted with, the LEA, and must meet training certification requirements (CPR).

Reference Documents: AHCCCS Medical Policy Manual, Chapter 700, Section 710

Behavioral Health Services

Behavioral healthcare is covered as:

  • Assessments
  • Cognitive skills training
  • Individual, group family therapy and counseling
  • Psychological and developmental testing
  • Neurobehavioral examinations and neuropsychological testing

Providers eligible for Medicaid reimbursement include:

  • Licensed Psychiatrists under Arizona Revised Statutes (ARS) Title 32, or state regulatory body where the psychiatrist resides
  • Licensed Psychologists under ARS 32-2061 or state regulatory body where the psychologist resides
  • Licensed Clinical Social Worker*
  • Licensed Professional Counselor*
  • Licensed Marriage and Family Therapist*

All providers must be registered with AHCCCS.

*Must be licensed by Arizona Board of Behavioral Health Examiners, or if outside Arizona, be licensed or certified to practice independently by local regulatory authority.

Reference Document: AHCCCS Medical Policy Manual, Chapter 700, Section 710

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 th3e 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.