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Sunday, August 27, 2023

Medicaid and IDEA

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for adults with intellectual and developmental disabilities

Shasta Kearns Moore and Emily Harris at NPR:
Since 1975, the Individuals with Disabilities Education Act (IDEA) has guaranteed children the right to a free public education, even if they have a disability that makes their education more expensive than average. Congress promised to fund 40% of those needs, but it's never even come close. In 2020, the National Education Association calculated the rate was just 13.2%.

Since 1988, Medicaid has slowly – though not completely – helped backfill for that lack of funding, allowing schools to get reimbursed for certain IDEA-required services, such as physical therapy for a child in a wheelchair.

But schools aren't always taking advantage.

Despite months of inquiries to districts in Oregon and across the nation, few officials would speak plainly and on the record about what's stopping them.

In an unsigned, emailed statement last spring, Winnie's school district, Portland Public Schools, described numerous barriers. Primary among them: The staff didn't think the burdensome process was worth it.

Wendy Niskanen, a board member for the National Association of School Nurses, echoed that concern: "Right now, the barriers are too great for most districts to do it."

Niskanen said schools aren't doctors offices, so they're not set up with the right training or software to do the kind of billing and documentation Medicaid requires.

It's a complaint Medicaid officials like Dan Tsai have heard from districts around the country.

"You have to bill for healthcare services in the same way that a hospital or a doctors office would bill, and most schools ... don't happen to have a medical expert coder sitting around."