The School-Based Health Care Services (SBHS) program reimburses school districts for Medicaid covered health care services provided to Medicaid eligible children in Special Education. These services must be included in the student's current Individualized Education Program (IEP) and be provided by a licensed health care provider.

Reminder

Each October, participating school districts must complete and submit a current Provider Update Form (PUF) with copies of each health care professional’s current license. For newly hired providers, a copy of their National Provider Identifier (NPI) is also required. Complete and return the PUF by mail, email or fax to (360) 725-1152. The form is located below under Resources.

Note: This is a district responsibility. Do not submit expired credentials as it will result in claims denial for that provider.

Program updates

SBHS program contract

Covered Medicaid services provided to Medicaid eligible Special Education students can be billed to the HCA when a school district contracts with HCA. Reimbursements are based on fee-for-service established rates, and are facilitated via an Intergovernmental Transfer (IGT) process.

Note: HCA has no affiliation with billing consultants. If a school district contracts with a billing consultant to assist in submitting Medicaid claims to HCA, the relationship between the district and its billing consultant is separate from its contractual relationship with HCA.

New Contractors: Complete and return the Contractor Intake Form by email or fax to (360) 725-1152. Disregard check-off list EXCEPT the requirement for your district's W-9. In addition, please email james.harvey@hca.wa.gov the following:

  • Name, title, phone, fax, and email of the employee who transmits the local matching funds.
  • Name, title, phone, fax, and email of the employee who will receive the contract from Medicaid.
  • Name, title, phone, fax, and email of the employee who will sign the contract.

When this required information in received, a contract between HCA and the district will be generated. Please send any questions regarding the contractor intake process to james.harvey@hca.wa.gov

Claiming

When a fully executed contract is in place, the district can begin submitting claims for Medicaid covered services. Please send any questions regarding the intergovernmental transfer process to HCA School Based Health Care Services.

Provider Qualifications Requirements

School-Based Health Care Services must be delivered by a health care provider who meets federal requirements and state licensure requirements according to Washington State law (WAC 182-537-0350).

Resources

Washington Connections

Washington Connection is designed for anyone who would like to find out what benefits and programs they might qualify for in Washington State. The online application is for residents of Washington State to apply for federal, state, or local benefits.

Washington HealthPlanFinder

To determine if a child is eligible for health care coverage, a parent or guardian can inquire or submit an application in one of the following ways:

  1. Online with the Washington Healthplanfinder at www.wahealthplanfinder.org.
  2. By calling the Customer Support Center at 1-855-WAFINDER (855-923-4633) or 1-855-627-9604 (TTY).
  3. By mail to:
    Washington HealthPlanFinder
    PO Box 946
    Olympia, WA 98507

In-person application assistance is also available. For information about in-person application assistance in your area, visit www.wahealthplanfinder.org or call the Customer Support Center.

Contact

School-Based Health Care Services for Children in Special Education
Health Care Authority
(360) 725-1153 or email

Medicaid Customer Service

For urgent issues, call Medicaid Customer Service Center at 1-800-562-3022.
Hours: Monday – Friday, 7:30 a.m. to 4:30 p.m.