Modern Medicaid Alliance Featured Medicaid Solution: Supporting Special Needs Students with the Care They Need to Succeed – Wayne County Regional Educational Service Agency (RESA)
The Challenge:
Wayne County Regional Educational Service Agency (RESA) provides services and support to more than 290,000 students in 33 school districts across Wayne County, Michigan. Their services are focused on improving student achievement and maximizing administrative efficiencies in Michigan’s most populous county.
More than 36,000 Wayne County students have special needs. Federal law mandates that they receive key services from the school district, including speech services, physical therapy, occupational therapy, and other specialized care. These services are required as part of an unfunded mandate, so school districts often must make tough choices to meet their obligations.
Medicaid Solution:
Wayne RESA’s School-Based Services Program has two parts:
- The Cost-Based Reimbursement Program provides health-related services to students through age 21 with special needs under the Individuals with Disabilities Education Act (IDEA);
- The Administrative Outreach Program identifies and helps students who are considered “at risk” for various health problems.
Medicaid helps reimburse Wayne RESA’s districts for health services identified in Individualized Education Plans (IEPs) for special needs students in the system – 21,000 of whom are covered by Medicaid. This provides significant financial assistance and allows students with special needs to receive high-quality health services.
The district has specific requirements and guidelines that they must follow to receive reimbursement for services in each program. For example, under the Cost-Based Reimbursement Program, special needs services must be provided by a qualified practitioner and be consistent with the intent of the IEPs’ identified services and planned goals.
More broadly, Wayne RESA districts provide health-related services to students, such as direct medical, personal care, and targeted case management services. Students receive services from audiologists, psychiatrists, licensed social workers, physical therapy assistants, primary care physicians, and many more trained personnel. Having the option to receive care at school makes it easier to ensure that students covered by Medicaid are staying as healthy as possible as they work toward achieving their educational goals.
As the registered Medicaid provider, Wayne RESA is also responsible for both filing and verifying claims to ensure services are health-related. While other school districts use third party companies to process claims, Wayne RESA completes administrative work in-house.
Medicaid Results:
Thanks to Medicaid, Wayne RESA can recoup some costs of providing services to students with special needs. The federal IDEA law promised 40% reimbursement to school districts to offset additional costs associated with care for special needs students; however, IDEA has only reimbursed 17% of that 40% promise leaving a significant gap. Without Medicaid, Wayne RESA districts would still provide all these necessary services to children in their schools but at the expense of other programs.