NAVIGATING THE COMPLEXITIES
Already feared by some for its arduous requirements, some Medicaid reimbursement is becoming harder to obtain
Written by Carol Brzozowski S
chool districts nationwide receiving Medicaid funding are strategizing as to how to respond to federal program cuts. The U.S. Department of Education (DOE) in-
dicates more than half of all school-aged children and youth nationally receive Medicaid funding. A March 2024 DOE report noted Medicaid pays anywhere from $4 billion to $6 billion annually to school districts for pro- viding services and is a large source of funding for many local educational agencies. Josy Campbell, transportation director for Harrison School District 2 in Colorado Springs, said that starting July 1, Colorado’s School Health Services Medicaid pro- gram will align with Center for Medicaid Service’s 2023 transportation guidance (State Medicaid Director Letter 23-006: Assurance of Transportation). This guidance clarifies that ordinary school transportation such as daily routes to and from school is considered part of a district’s general educational function and is not reim- bursable under Medicaid, Campbell said. “However, Medicaid reimbursement will remain
allowable for specialized transportation under the new guidance, when a vehicle is physically adapted to meet a student’s disability-related needs and that adaptation is documented in the student’s IEP,” she added. Examples include buses equipped with wheelchair lifts, air conditioning required for medical conditions, harnesses, or other qualifying equipment. “In those cases, districts may continue to claim reim- bursement for the bus monitor, as the monitor’s support is considered necessary to operate specialized equip- ment and ensure student safety,” Campbell said. What will change under the July update is that Medic-
aid will no longer reimburse bus monitors or attendants on routes not meeting specialized transportation criteria—meaning routes without qualifying adaptive equipment, she added. “This distinction could have a significant budget
impact for districts that currently staff monitors on all special needs routes, since those costs will need to shift
to local transportation budgets, unless the monitor is specifically required by a student’s IEP,” Campbell said. Medicaid reimbursement is also allowed for routes to a specialist or therapist, for example, the student needs and is outlined on the IEP for providing a specific medi- cal or rehabilitation services. The district hosts a scheduled Medicaid meeting Jan.
26, during which state officials are expected to provide detailed guidance on how these policy updates will be implemented and documented. “While federal law does not require monitors on school buses, many districts including ours, provide them as a best-practice safety measure,” Campbell said. “We are closely monitoring this change to understand its fiscal and operational implications and to ensure we remain compliant while continuing to prioritize student safety and support.” Meanwhile, Marshalltown Community School District
in Iowa maintains a list of students who qualify for Med- icaid reimbursement. “We use our routing software to determine the mileage and amount of time the individual is in the vehicle from the time they get on the bus and we get them to school, and from the time they get on the bus and we get them home,” explained Rex Kozak, transportation director, adding the driver signs off each time the student rides in the morning and afternoon. “We transport the students by our district buses or in
a district van. We have a partnership with the city bus transit system but none of the Medicaid students cur- rently ride the city bus to and from school,” he added. The Royse City Independent School District in Tex-
as, also receives Medicaid funding for eligible students. Cody Cox, executive director of transportation, noted that although the funding comes from the federal level, Texas requires the completion of weekly and monthly forms detailing when a student rode the bus. They must be signed by the bus driver and the monitor. When it comes to alternative transportation providers, districts usually handle reimbursements. Adroit noted
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