MESH Newsletter Archive
MESH Project Resources
State of Illinois Guidance and Resources
Sample parental consent form developed by the Illinois State Board of Education (ISBE).
FAQs on Illinois School-based Medicaid for school health service providers developed by HFS and ISBE.
FAQs on Illinois School-based Medicaid for school business officials developed by HFS and ISBE.
Official guidance from HFS (does not yet reflect changes in the State Plan Amendment).
Portal for administrative claiming and cost settlement.
Platform to assist Illinois families with applying for Medicaid and other benefits.
National Tools and Resources
Numerous materials that districts can use for Medicaid outreach and enrollment.
Illinois State Plan Amendment Information
Building off Schools Are Key to Improving Children’s Health, this brief looks at the state of children’s health and school staffing in Illinois and outlines the steps Illinois must take to amend its Medicaid state plan and increase access to health services.
In this recorded webinar, learn about a federal policy shift that allows billing for all health services provided to all students enrolled in Illinois Medicaid.
Answers to common questions about the Illinois State Plan Amendment and the benefits and changes to school Medicaid reimbursement.
School Medicaid Basics
This brief explores what Medicaid is, what it covers—in and out of school—and how school districts can leverage Medicaid to enhance school health services.
This webinar provides an overview of the Early and Periodic Screening, Diagnostic and Treatment Benefit (EPSDT) requirements.
This webinar recording describes the Medicaid program and what it covers, discusses how school districts can leverage Medicaid to enhance school health services, and provides information about the free care policy reversal and how states are leveraging this opportunity to expand their school-based Medicaid programs. Tips are shared on how key stakeholders, including school health providers and school superintendents, can support this work in their states and communities.
This national policy brief addresses the opportunities to expand on health services delivered within a school by school nurses and other district-employed providers.
This report reviews 33 audits of school-based Medicaid programs conducted by the Office of the Inspector General (OIG) and summarizes key findings. The report highlights what OIG looks for during audits and can be used to help states and school districts prepare for future audits. Sample checklists are included to help guide states toward developing robust internal guidance and policies that meet OIG expectations.
School Medicaid Expansion
This comprehensive, step-by-step guide provides background on school-based Medicaid and outlines various opportunities to advance state policy changes required to access federal funds.
This recorded webinar provides an in-depth look at trends in expanding school-based Medicaid programs, including detailed information about how states have successfully structured their programs. Presenters from Colorado and Michigan share how they expanded their programs and highlight key decisions they made along the way.
Presentation delivered by CMS for the Healthy Students, Promising Futures Learning Collaborative providing an overview of Medicaid reimbursement in the school setting. The presentation addresses issues including the free care policy, certified public expenditures, and telehealth.
The policy brief explains the importance of using a plan of care to document medical necessity, which is required for all school health services submitted for Medicaid reimbursement, and offers guidance on implementing plans of care for students without an IEP or 504 plan.
School Medicaid Policy Issues and Opportunities
Presentation by Kirsten Beronio, Centers for Medicare and Medicaid Services.
This report reviews reimbursement challenges across the country and demonstrates how alignment between state Medicaid and education standards for school health personnel can reduce barriers to Medicaid reimbursement for school health services.
This brief considers the circumstances under which school districts can bill their state Medicaid program for sudden and acute mental health crises that students may experience.
This policy brief includes information on how third party liability (TPL) applies to school-based health services and offers resources for additional reading.
In order to encourage school districts to maximize resources for school-based healthcare, state Medicaid programs must ensure that school healthcare providers are eligible for Medicaid reimbursement. This policy brief explains how states can resolve identifying school health personnel as Medicaid-qualified providers and shows how six states improved alignment.
School Medicaid Expansion Examples From Other States
These case studies reflect the work states have completed, and the success they have achieved, in leveraging federal Medicaid policy to expand physical, behavioral, and mental health services.
This Healthy Students Promising Futures Learning Collaborative case study highlights Michigan’s work to leverage the reversal of free care policy to expand the state’s school-based Medicaid program.
This regularly updated brief tracks state efforts to expand access to school health services, either through a state plan amendment or through legislative/administrative action, allowing school districts to bill Medicaid for health services delivered to all Medicaid-enrolled children.
Illinois School Medicaid Billing & Reimbursement Process
- Key Background Information: Illinois School-Based Health Services
- Getting Started With School Medicaid
Reimbursement Process Guidance
For detailed guidance on implementing each step in the reimbursement process, click on the links in the flowchart or the titles below.
- Obtain Consent to Bill Medicaid
- Identify Medicaid-Enrolled Students
- Identify Eligible Providers and Services (Summary Chart)
- Conduct Ongoing Training for Providers
- Update Provider Information Required by PCG
- Document Medical Necessity
- Provide and Document Services
- Respond to Random Moment Time Study (RMTS)
- Submit Service Claims to HFS
- Monitor Completion of Random Moment Time Study (RMTS)
- Submit Required Financial Reporting
- Review Reimbursement From State and Record to Designated Budget Category
- Monitor Compliance and Maintain Documentation
- District Needs Assessment Guide
- LEA Internal Program Review Checklist
- School Medicaid Calendar
- Commonly Used Acronyms
This guidance is intended to assist school districts with improving and expanding Medicaid reimbursement for school health services. It should not be construed as legal advice. The information is accurate to the best of our knowledge as of January 2023, based on a review of publicly available guidance from the Illinois Department of Healthcare and Family Services (HFS) and its partner Public Consulting Group (PCG), and discussions with subject matter experts. School Medicaid requirements are subject to change. Please refer to the most recent guidance from HFS and PCG.
2022 -2023 School Year
Office Hours: February 6, 2023
Identifying Eligible Providers and Services: November 17, 2022
• Identify Eligible Providers and Services Guidance Document
In-person Kickoff Meeting: October 13, 2022
• Team building activity
• Process map
• Needs assessment template
• Obtain consent
• Identify Medicaid-enrolled students
• Medicaid lookups
Outreach and Enrollment: September 28, 2022
• Promoting All Kids Health Insurance: Outreach and Enrollment Tips for Schools
2021-2022 School Year
Peer Call: December 15, 2021
Through training, technical assistance, and peer-to-peer learning opportunities, the MESH Learning Collaborative has helped teams from 23 school districts in Illinois increase sustainable revenue from Medicaid reimbursement, expand health services for students, and improve cross-departmental collaboration.
Collectively, the school districts that have participated in MESH impact over 400,000 students.
Please submit this form below any time you add new partners to your team so that we can include them in project communications.
Illinois Alliance of Administrators of Special Education
Illinois Association of School Business Officials
Illinois Association of School Nurses
Illinois School Counselor Association
Illinois School Psychologists Association
National Association of Social Workers, Illinois Chapter