Washington Apple Health (Medicaid): School-Based Services

Contact Information

Julee Christianson
Medicaid and School-Based Services Program Supervisor

Schools are essential access points for both physical and behavioral health. Decades of evidence show that when students receive needed services in school—where they spend the majority of their day—both academic and health outcomes improve.

Washington Apple Health (Medicaid) and the Children’s Health Insurance Program (CHIP), administered by the Washington Health Care Authority (HCA), provide health coverage to nearly 2 million Washingtonians, 800,000 of whom are children.

Local Education Agencies (LEAs) can use Medicaid to support and expand student services.

School-based Services Medicaid Modernization Update

HCA and OSPI are modernizing school-based Apple Health (Medicaid) services coming summer 2027, including:

  • Simplifying Medicaid claiming
  • Reducing burden
  • Expanding eligible services and providers
  • Using Random Moment Time Study (RMTS) for all staff, instead of individual billing

These updates align with the Centers for Medicare and Medicaid Services (CMS) Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.

Modernization FAQs 

  • School Staff 
  • District Leaders 
  • Families and Caregivers 
  • State Leaders and Policy Makers 
  • Community-Based Providers and Partners 
  • State Agencies and Technical Assistance Organizations 

Top 5 Things to Know About School-Based Medicaid

How School Districts Can Access Medicaid Funding

School-Based Medicaid - YouTube

In Summer 2027, Washington will be modernizing the Medicaid and School-Based Services Systems into a single pathway. Until then, Washington’s Local Education Agencies (LEAs)—which include school districts, charter schools, Tribal compact schools, and some Educational Service District programs—can access Medicaid reimbursement in three ways:

How School Districts Can Access Medicaid Funding

Washington’s Local Education Agencies (LEAs)—which include school districts, charter schools, Tribal compact schools, and some Educational Service District programs—can access Medicaid reimbursement in three ways:

School-Based Health Care Services 

Reimbursement for medically necessary services delivered to Medicaid-eligible students with disabilities who have an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Services May Include

  • Nursing
  • Behavioral health interventions
  • Occupational, physical, and speech therapy
  • Psychological services
  • Specialized transportation (as permitted)

New to SBHS? Start Here

Medicaid Administrative Claiming (MAC)

Partial reimbursement for school staff time spent helping students and families:

  • Apply for Apple Health (Medicaid)
  • Understand coverage
  • Access needed health or behavioral health services

MAC supports the broader school health ecosystem and can sustain positions such as nurses, counselors, psychologists, social workers, and administrative coordinators.

Administered by: HCA MAC Program.

Website: Public school districts | Washington State Health Care Authority

MAC Resources

Managed Care Organization (MCO) Contracts

LEAs may contract with managed care organizations to be reimbursed for medically necessary, Medicaid-covered services that:

  • Are not included in an IEP or IFSP
  • Are provided by qualified school-employed or contracted health staff
  • Meet the MCO's clinical and documentation requirements

These agreements support expanded access to services such as brief intervention, screening, care coordination, and behavioral health support.

Managed Care Programs (MCO Contracting)

Managed care | Washington State Health Care Authority

Medicaid Consent Form (Special Education Services)

Medicaid Consent for Students Receiving Special Education Services

Before districts can bill Medicaid for services provided to students with IEPs, families must complete a one-time Medicaid consent form.
This consent does not affect a family’s benefits, premiums, or access to other medical services. It simply allows the district to seek reimbursement for school-based health services already included in the student’s IEP.

To learn more or access the required forms and translated documents:
OSPI Medicaid Consent Form for Special Education Services

OSPI has developed videos to help explain the importance of the OSPI Medicaid Consent Forms:

Apple Health Eligibility and Enrollment Outreach

What do the Federal Medicaid Changes Mean for School-Based Medicaid? (YouTube video)

Recent federal cuts to Medicaid are not expected to directly impact School-Based Medicaid programs. However, cuts may impact family and student enrollment, which could impact district reimbursement. HCA has developed the School-based services Apple Health (Medicaid) toolkit to help LEAs support Apple Health outreach, education, and engagement efforts.

Resources

Frequently Asked Questions

Will data collected for Medicaid be shared with other federal agencies?

Certain data from Apple Health (Medicaid) must be shared with the Centers for Medicare & Medicaid Services as required by federal law. Washington State cannot control sharing of that data amongst federal agencies. The use of that data by agencies such as U.S. Department of Homeland Security (DHS) or Immigration and Customs Enforcement (ICE) for immigration-enforcement purposes has been legally challenged by numerous states. A recent US District Court ruling permits certain biographical information to be shared from CMS to ICE, but future legal action is still pending.

Do school-based services take away from community-based providers?

No. School-based services strengthen, rather than replace, community-based care.
Schools are part of a broader continuum, improving coordination and increasing access—especially for students who face barriers to receiving care in traditional settings.

How do HIPAA and FERPA apply to school health and education records?

Most student records maintained by schools are education records covered by FERPA, not HIPAA.
Because schools are generally not HIPAA-covered entities, HIPAA rarely applies—except in limited situations involving external medical providers or certain electronic systems.

Resources:

Note: OSPI and HCA are developing updated guidance on HIPAA, FERPA, personal health information (PHI), and electronic health records to support districts and families.

Will billing Medicaid for IEP/IFSP services through the SBHS program affect a child’s Medicaid coverage or other benefits?

No, participation does not in any way impact Medicaid services the child receives outside of school. Parents are not required to enroll in Medicaid or insurance programs for their child to receive special education and related services under Part B of IDEA.

Is billing Medicaid sustainable? Will funds run out?

School-based Medicaid is a safe and reliable funding source. School-Based Medicaid is a protected, federally supported funding stream.
Recent legislation (e.g., HB 2494) does not draw from School-Based Medicaid. Federal matching funds continue to support health and behavioral health services in schools, allowing LEAs to reinvest federal dollars into student well-being.

Schools also strengthen long-term access to care by connecting families to Medicaid coverage and providing reimbursable services directly.

2026 Professional Learning Community

Recordings and slide decks are available from the 2026 Medicaid and School-Based Services Professional Learning Community webinars.

Stay tuned for 2027 PLC registration and information coming soon!