Washington Apple Health School-Based Medicaid

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 mission Washingtonians – 800,000 of which are children.

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

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:

Delivering Services in School-Based Settings

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:

• SBHS 101 training video | pdf
• SBHS checklist for new districts

Administered by:
HCA School-Based Services Program/School-Based Health Care Services (SBHS)
Email: HCA school-based services

Medicaid Administrative Claiming (MAC)

LEAs may contract directly with Medicaid managed care plans 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)
Email: HCA managed care programs
Managed care Washington State Health Care Authority

Managed Care Organization (MCO) Contracts

LEAs may contract directly with Medicaid managed care plans 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)
Email: HCA managed care programs
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 also access translated documents:
OSPI Medicaid Consent Form for Special Education Services

Resources

• Medicaid-Funded School-Based Services & Supports Fact Sheet (2023)
• School-Based Behavioral Health Medicaid Billing Toolkit
• SBHS VS SBHC

Frequently Asked Questions

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.

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.

Resources:

Does HIPAA Apply to Schools? 2025 Update Joint Guidance on FERPA and HIPAA HCA 60-0077 | Washington Health Care Privacy Toolkit 

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.

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