School-Based Medicaid Reimbursement Advocacy Roadmap

The Roadmap will provide states with key materials and resources to plan your association’s response. State association leaders and members need to actively monitor and respond to any changes in school-based psychological services and limitations placed upon these services provided by school psychologists.  Some districts may attempt to shift counseling caseloads or hire professionals who are Medicaid “qualified” providers in lieu of school psychologists. Regardless of changes in reimbursement procedures, school districts are obligated to continue to provide mandated services to all students and school psychologists need to know how they can best contribute to this effort. 

How to Use Your Advocacy Roadmap

The NASP Advocacy Roadmap: School-based Medicaid Services contains a variety of materials and resources for developing a coordinated state and national level of response to changes in Medicaid reimbursement for school psychological services. NASP leaders and staff are providing this information as a resource for state leaders. Since Medicaid State Plans and credentialing standards are prerogatives of state governments, school psychology leaders within states wishing to respond to changes within their state should become familiar with the content of the Roadmap and begin working at the state level to identify areas of need and appropriate activities for advocacy. This Roadmap is meant to support the work of states and is not exhaustive in its content. State leaders are encouraged to review all of the materials posted at this site and think creatively and broadly about their local response to policy proposals related to school-based Medicaid services. Ultimately, state leaders and associations will need to craft their own unique response based upon the issues and policies of their state.

Special Considerations

The purpose of this roadmap is to provide basic background information and access to resources for additional information concerning the Medicaid program. The content here should not be viewed as legal or accounting consultation. Some states and districts within states have been able to obtain substantial financial reimbursement from the Local Education Agency (LEA) Billing Option in the Medicaid program.  However, states vary dramatically in the content of Medicaid plans that can directly affect a district’s ability to successfully bill for Medicaid administration and services. The plan stipulations are complicated and are best understood by the practitioners residing in each individual state. In those states where the Medicaid plan allows school district billing, the process by which individual districts access and utilize this resource varies greatly. There are many roadblocks and challenges to meet in utilizing Medicaid cost recovery in schools and the purpose of this roadmap is to help you navigate those potential roadblocks through access to information and advocacy planning.

Table of Contents

Exhibit A: Introduction to School-Based Medicaid Services
This is a brief handout that summarizes key issues related to Medicaid and recent changes that have impacted the provision of school-based psychological services to Medicaid eligible students.

Exhibit B: Brief Summary of the Federal Medicaid Statute
This document offers a brief review of the authorizing statute supporting school-based Medicaid services.

Exhibit C: Summary of the U.S. Department of Health and Human Services Office of Inspector General’s Medicaid Audits
This summarizes the OIG audits of school-based Medicaid services.

Exhibit D: State Attorney Generals’ Opinions Related to School Psychology
State Attorney Generals have been asked to offer opinions related to school psychologists and school psychological services.  This section summarizes many of these opinions, including the Oklahoma State Attorney General’s Opinion letter related to the equivalency of school psychologists’ scope of practice and licensed psychologists’ scope of practice in Oklahoma.

Exhibit E: State Responses to Changes in Medicaid Reimbursement for School Psychological Services Survey
A survey was conducted with state school psychology associations’ executives, NASP SPAN Coordinators, and NASP State delegates to ascertain changes in school-based Medicaid services.  A total of 33 responses from 28 states were received.  This section contains comments and feedback provided by various states.

Exhibit F: Checklist for State Advocacy Planning
Responding to changes in Medicaid reimbursement procedures for school psychological services requires careful planning by state associations. This document summarizes the major advocacy activities that need to be addressed in order to provide a comprehensive and coordinated response.

Exhibit G: Profile of School Psychology Credentialing and Psychologist Licensing Related to School-based Psychological Services
It is recommended that every state gather information about the school psychology credentialing and psychologist licensing practices of their state. This Credentialing Profile will help states identify key information, public policy makers, and licensing and credentialing procedures so that school psychologists in each state are prepared to mount a grassroots advocacy campaign in response to changes in reimbursement procedures.

Exhibit H: Summary of School Psychology Advocacy Materials
This handout provides links to a variety of advocacy materials developed to help state associations fine-tune their message regarding the critical importance of the services provided by highly qualified non-doctoral school psychologists.

Exhibit I: State Advocacy Action Plan Template
This is a template to help state associations create an effective advocacy plan in response to changes in Medicaid reimbursement for school psychological services. This tool will assist states in identifying specific goals, associated activities, timelines, personnel responsible, needed resources, and anticipated outcomes.

Exhibit J: Risk and Asset Assessment Questionnaire
This document is designed to help state associations determine the degree of risk and their assets in responding to potential changes in Medicaid reimbursement procedures for school-based services.

Exhibit K: Summary of Critical Resources for States
This document provides a summary of critical online links to general Medicaid resources, related websites and allied professional groups. It includes links to state level resources and sample items from states.

Exhibit L: Frequently Asked Questions About Working with a Lobbyist
One strategy that states may use in responding to changes in Medicaid reimbursement procedures is to hire a lobbyist to help in monitoring and responding to unfriendly legislation or regulations. This guide provides helpful tips on working with a lobbyist.

Exhibit M: Assistance Available to States
This document summarizes resources, materials, and leader and staff contacts that NASP is able to provide state associations in mounting a campaign to defeat any unfriendly proposals emerging from changes in Medicaid reimbursement procedures.

Exhibit N: The NASP Advocacy Roadmap for States: School-Based Medicaid Services Presentation
This includes a PowerPoint presentation from NASP Boston Convention, 2009 introducing the School-Based Medicaid Services roadmap.