What Oregon Districts Should Know About School-Based Medicaid Right Now

Working alongside Oregon districts, we keep seeing the same few things trip people up, and the same few things open doors. Here is the short version for special education directors and Medicaid coordinators.

You Are Already Doing the Work

Your nurse checks on students all day. Counselors meet with kids who are having a hard week. Aides help students eat, use the restroom, and get through class. Most of that is paid for out of your own budget.

School-Based Medicaid does not add services to anyone’s plate. It lets you be reimbursed for the ones that qualify, and that money comes back to your district. If you are running tight on funding, it is worth knowing what you may be leaving unclaimed.

Oregon Gives You More Room Than Many States

Many districts start with IEP services like speech, OT, and PT. A 2023 state plan amendment expanded Oregon’s coverage beyond IDEA, so services can be billed under documented individual plans of care, like a nurse treatment plan or a behavioral health service plan, for students without an IEP. If special education is already stretched, you may not have to begin there. Three places to look:

• Nursing. Care for students with health needs, including students without an IEP whose nurse has documented a plan of care.
• Behavioral health. Counseling and clinical services from qualified providers. Oregon has been widening which school-licensed providers can bill, so check the current provider list with OHA.
• Personal care. Help with eating, toileting, dressing, and grooming, plus delegated nursing procedures done by trained staff like an instructional aide. This one is easy to overlook.

Next step: ask your student support team what they already document, and whether a plan is in place for those students.

About Those Medicaid Headlines

You have probably seen the news about Medicaid changes. Under the 2025 federal budget law, states must require adults in the Medicaid expansion group, through age 64, to meet work requirements starting January 1, 2027, according to KFF. Parents and caretakers of children 13 and under are exempt.

School-Based Medicaid has a long track record. States have been able to draw down federal Medicaid funds for school health services since 1988, according to MACPAC, and a 2014 CMS policy change ended the “free care” rule that had limited what Medicaid could pay for in schools. Oregon’s waiver runs through September 30, 2027, and per the Oregon Health Authority it keeps children continuously enrolled until their sixth birthday and provides two years of continuous eligibility for ages six and up.

Next step: when you see a Medicaid headline, check whether it is about the broader program or the school-based piece before you pause any planning.

Before Your First Claim

A few things need to be in place before anything bills:

• Parental consent, where it is required
• Enrollment for your education agency as a School Medical Provider, and NPIs and OHP enrollment for the providers delivering services
• Cost-based rate setting, done with your business office

Providers already document their services, so most of the effort is up-front setup. A Medicaid team that knows Oregon makes that setup far lighter, and it is also your best protection when it comes to audits.

Next step: map out who owns each of those pieces in your district, and where consent could fit into registration.

Want to Go Deeper?

Relay pairs every district with a dedicated Medicaid expert who knows your state and guides you through each rule change.

Missed our Oregon webinar? Watch the recording here.

This post reflects what we are seeing and early guidance from the field. It is not legal or billing advice. Please confirm requirements with the Oregon Health Authority.

Looking to continue the conversation? Schedule a conversation with an Oregon Medicaid Liaison from Relay.