CMS Issues Guidance on Medicaid and CHIP Services in School-Based Settings

On May 18, 2023, the CMS, in consultation with the DOE, released new guidance to support state Medicaid and Children’s Health Insurance Program (CHIP) agencies (SMAs), state education agencies (SEAs),1 and local education agencies (LEAs)2 in working together to deliver covered Medicaid and CHIP services in school-based settings.

These school-based services (SBS) are critical health and health-related services provided to students and their caregivers in the school setting and can be covered by Medicaid and CHIP. This guidance, Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming, was accompanied by a CMS Informational Bulletin summarizing the guidance for states and announcing the launch of the joint CMS and DOE SBS Technical Assistance Center.

This brief summarizes CMS’ new guidance and highlights implications of the guidance for state agencies and local partners. The summary is tailored to meet the needs of SMAs, SEAs and LEAs to help demystify reimbursement and funding opportunities for SBS and support providers and advocates and anyone else with an interest in SBS.

To download the full white paper, click here.

1 Also known as state departments of education.

2 An LEA is defined as “a public board of education or other public authority legally constituted within a state for either administrative control or direction of, or to perform a service function for, public elementary schools or secondary schools in a city, county, township, school district[] or other political subdivision of a state, or for a combination of school districts or counties as are recognized in a state as an administrative agency for its public elementary schools or secondary schools.” See 34 C.F.R. § 303.23(a) here.



pursuant to New York DR 2-101(f)

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