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Section 6

ak dept education

special ed handbook
SECTION 6
METHODS OF ENSURING SERVICES

Public Insurance

The District may not require parents to sign up for or enroll in public insurance programs in order for their child to receive FAPE under IDEA. The District may not require parents to incur an out of pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim for services. The District may pay the cost that the parent otherwise would be required to pay.

The District may not use the child’s benefits under a public insurance program if that use would:
  • Decrease available lifetime coverage or any other insured benefit.
  • Result in the family paying for services that would otherwise be covered by the public insurance program and that are required for the child outside of the time the child is in school.
  • Increase the premiums or lead to the discontinuation of insurance.
  • Risk the loss of eligibility for home and community based waivers, based on aggregate health related expenditures.
Private Insurance

With regard to services required to provide FAPE to an eligible child under IDEA, the District may access a parents private insurance proceeds only if the parent provides informed consent consistent with IDEA. Each time the District proposes to access the parent’s private insurance proceeds, it must:
  • Obtain parental consent in accordance with IDEA
  • Inform the parents that their refusal to permit the public agency to access their private insurance does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents.
Use of Part B Funds

Should the District be unable to obtain parental consent to use the parent’s private insurance or public insurance when the parent would incur a cost for a specified service to ensure FAPE the District may use its Part B funds to pay for the service. To avoid the financial cost to parents who otherwise would consent to the use of private or public insurance if the parents would incur a cost, the District may use its Part B funds to pay the cost the parents otherwise would have to pay to use the parents insurance (e.g., the deductible or co-pay amounts.)

Proceeds from public or private insurance

The proceeds from public and private insurance will not be treated as program income by districts. If the District spends reimbursements from Federal funds (e.g., Medicaid) for services under IDEA, those funds will not be considered “state or local” funds for purposes of the maintenance of effort provision in IDEA.

Important Note:

There is nothing in the handbook or state and federal law that should be construed to alter the requirements imposed on a State Medicaid agency, or any other agency administering a public insurance program by Federal statute, regulations or policy under Title XIX or Title XXI of the Social Security Act, or any other public insurance program.

School Based Medicaid Services (April 2003)

Generally, children who have been determined to be eligible by Medicaid for services identified under the State Medicaid Plan, those services may be available in the school setting.

These services are in the process of being defined. Billing mechanisms are being defined. Provider qualifications are being defined.

The Department of Health & Social Services, Division of Medical Assistance is responsible for regulations and payment for eligible services to eligible children.

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