Increase Your School-Based Medicaid IQ in 3 Easy Steps



As the end of the 2021-22 SY approaches, student assessments are being finalized and plans are being made to set them up for success upon their return from summer break. This break is the perfect time for your team to increase their School-Based Medicaid IQ!

For those of you who work in Special Education Administration, handle the day to day of your districts Medicaid program or are a school-based service provider, you know that dealing with Medicaid documentation can be complex. The journey from when a student is identified for service through documentation and billing can raise a lot of questions and cause undue stress. The fact is, while billing for Medicaid can immensely benefit your school district and allow you to use reimbursed funds to increase support for your students and hire additional staff, there are a lot of components that go along with it.

These components and more are areas that we support our district partners with, and we want to share some with you! We reached out to Danielle Richards and Tiffany Guinan, two of our top Medicaid Experts at CompuClaim, for their top 3 ways to increase your School-Based Medicaid IQ. 

1. Know your state terms for School-Based Medicaid! 

Each state will have their own rules for documenting and billing for Medicaid. It’s important to get familiar with the rules and terms used at the state level. Our first recommendation is to look and see if you state has a School-Based Medicaid Manual. Think of the manual as your “How-To Medicaid Manual.” It will provide you with general information, key definitions, and types of services that are reimbursable.

This information usually comes from the larger, Medicaid State Plan Amendment (SPA). According to, The SPA is “an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities.” Concisely, the SPA will outline all the specifics and nuances for Medicaid reimbursement at the state level–but can be a complex document, so we suggest starting with the School-Based Medicaid Manual.

These documents can also help you understand if billing is beneficial for your district both financially and timeliness. Billing for school-based Medicaid does require investment and you want to make sure you are getting a return on that.

cool Pro tip: Make sure you are understanding the types of services you can claim and make sure your staff has the right licensure and certifications. Work with you vendor to help you make sure you are not leaving anything behind or any money on the table. 

2. Get on the list! 

Emails and newsletters can provide relevant and targeted content for you to digest at a time that works best for you. We recommend signing up to receive regular communications that can aid your knowledge and professional development. One of the best ways to do this is to first check with that state point of contact previously mentioned. Most states will have an email you can subscribe to that helps you stay up to date with upcoming changes, new initiatives, informational webinars, and networking opportunities to contact likeminded professionals.

Another great resource for School-Based Medicaid is the National Alliance for Medicaid Education (NAME). This non-profit organization is comprised of members from the nation’s school districts and state Medicaid and Education agencies who are involved in administration of Medicaid claiming for school-based services. NAME providers a variety of resources and they also have an excellent yearly conference every autumn. 

cool Pro Tip: Subscribe to the CompuClaim blog to get monthly school-based Medicaid tips and best practices delivered monthly to your inbox. If you are interested in learning about ways to find more state-specific content let us know, we are happy to help!

Save the Date for Medicaid Training Webinar!

Do you have summer learning plans in place for your district Medicaid team?  

Join us this July 26 to learn tips and tricks to onboard new faces or get a refresher for your current team members!  

Save Your Seat

3. Reach out to experts.  

Remember that you do not need to tackle your entire Medicaid documentation and billing workflow by yourself. There are people and resources ready to support and boost your Medicaid knowledge. For example, who is your current Medicaid vendor? They should have state-level expertise, on staff, prepared to guide you through the complexities of documentation, claims submission, compliance, audit support, and cost reconciliation. Your vendor should also be offering regular training and provide support on best practices to make sure you are maximizing your reimbursements to get that return on your investment we talked about earlier.

Another option to tap into expertise is reaching out to other school districts as well as attending conferences or professional development opportunities. Peer knowledge-sharing is a powerful tool and it is often advantageous to see how other districts are handling their Medicaid billing. Your neighboring districts might be implementing best practices that you can use and benefit from at your district.

cool Pro Tip: Is your district a School-Based Medicaid Maverick? Share your best practices to help other schools in your state thrive and maximize their reimbursements! Teach what you know!

These three things can help you increase your School-Based Medicaid IQ and allow you to help train staff as transitions occur. With the right tools and knowledge in place, you can have a streamlined Medicaid documentation and billing workflow that reduces administrative burdens and maximizes reimbursements. With that in place, you can focus on what really matters: supporting your students!

Looking forward to taking the next steps? Reach out to a Medicaid Specialist to answer specific questions you may have at the state or district level.