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LEA Medi-Cal Billing Option

State and Federal Authorization for LEA Medi-Cal Billing Option Program

The Local Education Agency (LEA) Medi-Cal Billing Option Program is a fee-for-service program authorized by state and federal governments. In 1986 Congress authorized schools to bill the Medicaid (note: in California, Medicaid is called Medi-Cal) program for some health-related services for students with disabilities. The health-related services for students with disabilities include both assessments and the treatments specified on a student’s Individualized Education Program (IEP) including: audiology, counseling, nursing services, occupational therapy, physical therapy, speech therapy, and transportation related to these services. Medi-Cal regulations set the same high professional standards for school-based providers as providers who work in hospitals, rehabilitation centers, and other settings.

As per the Individuals with Disabilities Education Act (IDEA) regulations, the Del Norte Unified School District (DNUSD) provides all required services as specified on a child’s IEP at no cost to parents. However, DNUSD can be reimbursed for the cost of those services from the federal government’s Medicaid program – which increases the ability to provide health-related services for all DNUSD students.

Parents of students who are Medi-Cal eligible authorize DNUSD to submit claims for reimbursement by Medi-Cal for Medi-Cal funded services when a parent signs consent for a Special Education Assessment Plan or an IEP. The frequency of claims is aligned with assessment authorizations and/or the type and frequency of the Medi-Cal funded services a parent authorizes on the student’s IEP.

School-based Medi-Cal reimbursement does not affect the child’s Medi-Cal benefits in other health care settings and there is no cap on Medi-Cal for students with disabilities in California. DNUSD never bills a family’s private insurance for the health care services specified on a child’s IEP. The District adheres to IDEA and its requirement to provide students with disabilities with a free and appropriate public education (FAPE).

Please click here to read more about the LEA Medical Billing Option Program

DHCS Logo. Click here to learn more about the LEA Medical Billing Option Program.