Connecticut School Medicaid Snapshot

Expansion of School Medicaid Program
Connecticut has expanded its school Medicaid program to the health services included in a child’s IEP or Section 504 plan.

Coverage & Billing
Connecticut covers the following school-based health services:

  • Assessments
  • Audiology Services
  • Behavioral Health Services (psychological and counseling)
  • Clinical Diagnostic Laboratory Services
  • DME and Medical Supplies and Devices
  • Medical Services
  • Nursing Services
  • Occupational Therapy
  • Physical Therapy
  • Speech Therapy
  • Optometry Services
  • Personal Care Services
  • Respiratory Care Services
  • Transportation Services

Eligibility: Medicaid-eligible children ages 3 to 22 for covered medically necessary services provided pursuant to an IEP or Section 504 plan.

Billing: The billing providers are the Local Education Agencies (LEAs). Rendering providers do not need to enroll in Medicaid separately, but they do need to meet appropriate provider qualifications to provide services. Connecticut does not have Medicaid managed care.

Reference Document: SPA 16-0014; SPA 10-018; Medicaid School Based Child Health Program User Guide

Nursing Services

Nursing services are covered as:

  • Assessment and development of individualized healthcare plans
  • Medical treatments and procedures including, but not limited to, suctioning, tracheotomy care, catheterization, toileting, ostomy management and care
  • Administration monitoring of medication
  • Consultation with licensed physicians, parents, and staff regarding effect of medication
  • Monitoring of health status, for example, monitoring of shunt functioning or respiratory status
  • Individual health counseling and instruction and emergency interventions

Providers eligible for reimbursement:

  • Licensed APRNs
  • Licensed RNs
  • Licensed LPNs

Reference Documents: SPA 16-0014

Behavioral Health Services

Behavioral health care is covered in schools as:

  • Mental health evaluations
  • Psychological testing
  • Counseling services

The types of providers eligible to provide the service for Medicaid reimbursement purposes include:

  • Physicians
  • Psychiatrists
  • APRNs
  • Physician Assistants
  • Clinical Psychologists
  • School Psychologists
  • School Social Workers
  • LCSWs
  • LPCs
  • School Counselors
  • Alcohol and Drug Counselors
  • School LMFTs
  • LMFTs
  • Certified Guidance Counselors

Reference Document: Connecticut Medicaid School Based Child Health Program User Guide; SPA 16-0014

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