Washington Apple Health (Medicaid): School-Based Services

Contact Information

Bridget Underdahl
Assistant Director, School Health Systems & Medicaid Strategy

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 through several reimbursement pathways.

Top 5 Things to Know About School-Based Medicaid

 

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

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.