Expanding Free Care in Virginia Schools: A New Opportunity for Districts

Expanding Free Care in Virginia Schools: A New Opportunity for Districts

If you’re a district in Virginia struggling to manage or even get started with claiming extended services, there’s some exciting news on the horizon. Since July 1, 2022, Virginia’s Medicaid State Plan Amendment (SPA) has opened the door for expanded reimbursement options—what many are now calling “Free Care.” This policy change is making it easier than ever for districts to access federal funds for a wide range of health services, without the traditional limitations of special education requirements.

What’s New Under Free Care in Virginia Schools?

Traditionally, Medicaid reimbursements for school-based services were only available when services were documented in a student’s Individualized Education Program (IEP). However, with the SPA in place, that requirement has been removed for most services. Now, districts can claim reimbursement for a broad array of services provided to all Medicaid-enrolled students—even if those services aren’t tied to special education.

Directly Reimbursable Services

The new policy covers an expanded list of direct services, including:

• Physical Therapy
• Occupational Therapy
• Speech Language Pathology
• Audiology
• Mental/Behavioral Health Services
• Nursing Services
• Medical Evaluations
• Personal Care Services
• Applied Behavioral Therapy
• EPSDT Physicals

Note: While specialized transportation remains billable, it still requires the service to be part of an IEP.

Additionally, evaluations for these services are considered covered services as long as they meet DMAS requirements for partial reimbursement.

Expanded Coverage Beyond Special Education

The SPA not only broadens the list of reimbursable services but also expands the types of providers and administrative activities that can be billed. Key enhancements include:

• Billable Services Outside of Special Education: With the exception of transportation, services no longer need to be tied solely to special education.
• Expanded Provider Eligibility: Now, behavioral and mental health services can also be provided by VDOE-licensed psychologists and school counselors.
• New Direct Reimbursable Service: Applied Behavioral Therapy is now a direct reimbursable service.
• Public Health as an Administrative Activity: This change recognizes the role of public health initiatives within schools.
• Transportation Update: Transportation costs are now settled quarterly without the need for claims submission, and the definition has been broadened to include adapted cars and other specially adapted vehicles.
• Crisis Care and Screening: Expanded to ensure that critical, time-sensitive interventions are also covered.

Why This Matters

For many Virginia districts, navigating the complex world of Medicaid billing has been a major hurdle. With the removal of the IEP restriction and the expansion of eligible services and providers, more schools can now take advantage of federal funding. This “Free Care” solution is an easy and efficient way for Relay—and your district—to solve long-standing challenges in accessing the funds needed to provide comprehensive student health services.

By leveraging these changes, districts can:

• Enhance Student Health: Provide a wider range of services to all Medicaid-enrolled students, ensuring they have access to essential care.
• Improve Financial Sustainability: Tap into additional federal funding to support school health programs and offset local budget constraints.
• Streamline Administrative Processes: With new billing methods and expanded definitions, the reimbursement process becomes simpler and more predictable.

What’s Next?

If your district is ready to explore these new opportunities, consider reaching out for technical assistance or partnering with state-level initiatives to ensure a smooth transition. With many states already participating in Free Care, Virginia’s recent policy changes are paving the way for broader adoption and more robust school health services across the Commonwealth.

For further details or assistance on how to begin claiming these expanded services, please contact Relay or visit the DMAS website.

Interested in finding out how to start incorporating these services into your district Medicaid program? Reach out to Relay—your School Medicaid Billing Software specialists.