Medicaid Billing Information

  • The West Linn-Wilsonville School District is committed to providing health services and resources so that ALL students have access to their education. These services include health management protocols, Section 504 Plans, and Individualized Education Plans.

    In our constant pursuit to achieve that goal, the district has found a new way to access available federal funds for health services in 2018-19, but we need the help and consent of our families. To access these funds, the district will begin billing Medicaid directly for health services that are provided as part of an Individualized Education Plan. A child and family's insurance benefits will in NO WAY be impacted by providing consent.

    Two Separate Opportunities for Increased Federal Funding:

    As part of Senate Bill 111, the State has outlined two methods in which the district can access additional federal funding. Those methods include:

    • Medicaid Administrative Claiming (MAC) — the district ALREADY participates in this program
      • Medicaid Administrative Claiming reimburses the district for outreach activities to connect students to outside health providers and coordinate that care with school. To access this funding, district employees complete surveys at different times throughout the year.
    • Medicaid Billing — This is the new program that the district will begin participating in this fall.
      • The school district will bill Medicaid directly for health services that are provided as part of an Individualized Education Plan.

    By billing Medicaid directly the district can:

    • Access federal funds
    • Use those funds for paying for costs of health-related staff
    • Provide school health providers with a system for documenting their care notes
    • Reimburse the district for actual costs of providing nursing services on IEPs for students who are Oregon Health Plan Eligible as well as Occupational Therapists, Physical Therapists, and Speech-Language Pathologists.
    • Confidentiality is maintained throughout the process
    • Consent of parents is REQUIRED

    It's important to note that there is NO IMPACT on the benefits a child or family can receive for health needs outside of school, and there is NO IMPACT on the child's access to special education services or a free and appropriate public education. 

    Benefits of Medicaid Fee-for-Service Billing

    • Creates a partnership to support the medical services that are specified on a student's Individualized Education Plan (IEP)
    • Resources are maximized
    • It's an efficient method of providing necessary medical care to Medicaid-eligible students
    • Leverage of federal funds to recover a portion of the costs that have already been incurred

    What We Need To Start

    • Partnership with our West Linn-Wilsonville Health Service providers
    • Partnership with our Information Technology Department
    • Partnership with our Business Department
    • Partnership with our Clackamas Education Service District
    • Partnership with our PARENTS
      • This includes a consent form that will now be included as part of our Special Education Paperwork
      • This consent form will protect the confidentiality of students and families