Delaware School Medicaid Snapshot

Expansion of School Medicaid Program
Delaware has not expanded its school Medicaid program beyond school health services documented in a student’s IEP or IFSP.

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

  • EPSDT Screens
  • Nursing Services
  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Audiology Services
  • Rehabilitative Services
  • Specialized Transportation

Eligibility: Medicaid-eligible children under the age of 21 for covered medically necessary services provided pursuant to an IEP/IFSP.

A treatment plan or IEP is not required for assessment services. School-based treatment services are covered for children with special needs who do not have an IEP but must be documented in the child’s treatment plan.

Billing: The billing providers are the Local Education Agencies (LEAs). Rendering providers must enroll in Medicaid.

Reference Document: Delaware Medicaid State Plan 14 DE Admin 923.54.5

Nursing Services

Nursing services are covered as:

  • One-on-one individualized health education
  • Individual nursing treatment, including personal care which is medically necessary and requires nurse intervention or evaluation (e.g., tube feedings; catheters; tracheal care; would care; diabetic care; bladder care, etc.)
  • Medication administration and monitoring

Providers eligible for reimbursement include RNs, LPNs and delegated professionals. Unlicensed professionals may operate under the direction of a licensed practitioner who acts as supervisor and is responsible for the work, plans the work and methods, who regularly reviews the work performed and is accountable for the results.

Supervision must adhere to the requirements of the practitioner’s applicable licensing board.

The licensed practitioner must co-sign documentation for all services provided by practitioners under his or her direction.

Reference Documents: School Based Health Services: Provider Policy Manual

Behavioral Health Services

Behavioral health care is covered in schools as: rehabilitative behavioral health services, including psychological and developmental assessment, case consultation, and counseling and therapy (individual/group).

Providers types eligible for reimbursement:
Assessment services:

  • Licensed Psychiatrist
  • Licensed Psychologist
  • Certified School Psychologist

Treatment services:

  • Licensed Psychiatrist
  • Licensed Psychologist
  • Certified School Psychologist
  • Licensed RN
  • Licensed Professional Counselor of Mental Health
  • LCSW
  • Master of Social Work under supervision of licensed professional
  • Master of Clinical Psychology under supervision of licensed professional
  • Master of Counseling under supervision of licensed professional

Unlicensed professionals operate under the direction of a licensed practitioner. Licensed practitioners must co-sign for services provided under direction.

Reference Document: School Based Health Services: Provider Policy 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.