The School-Based HealthCare Services (SBHS) program reimburses school districts for covered healthcare services provided to Medicaid eligible children in special education. These services must be included in the child's current Individualized Educational Program (IEP) and be provided by a licensed healthcare provider.
The Health Care Authority (HCA) is pleased to welcome Jim Harvey, Ed.S. as the new SBHS Program Specialist for the School-Based Healthcare Services program. Read more about Jim.
HCA sent the Medicaid in Education 2011-2012 announcement to school districts on September 1, 2011, updating the status of the SBHC. Because funding for the program and the requirements to set up a new intergovernmental transfer (IGT) came so quickly, HCA needed to get contracts out quickly.
Letter regarding MAM claiming 7/9/13
Purpose: Contracts between HCA and the school districts gives HCA the authority to reimburse school districts for Medicaid covered healthcare related services provided to Medicaid eligible special education students.
Note: A school district may choose to contract with a billing consultant to assist in submitting claims to Medicaid. The relationship established between a billing consultant and a school district is completely separate from a school district's relationship HCA. HCA has no affiliation with billing consultants in Washington State.
Contractor Intake Form: Complete and return the Contract Intake Form by email or fax to (360) 664-0261. Disregard the check off list at the bottom of the form EXCEPT for the requirement for your district's W-9. In addition, please send an email to firstname.lastname@example.org providing responses to the following:
- The name, title, and email of the person who transmits the transfer of local matching funds to Medicaid.
- The name, title, and email of the person who will RECEIVE the contract from Medicaid.
- The name, title, and email of the person who will SIGN the contract.
Billing and Payment: The sooner HCA receives a signed contract from a school district, the sooner HCA can reimburse for Medicaid covered services delivered on or after the date of contract execution. HCA will send out a contract after receiving a Contractor Intake Form (CIF).
Please send questions regarding (IGT) process or accounting issues to HCASchoolBased@hca.wa.gov.
Provider Qualifications Requirements
School-Based Health Care Services must be delivered by a healthcare provider who meets both federal and state licensure requirements according to Washington State law (see WAC 182-537-0350).
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.
To determine if a child is eligible for health care coverage through the State of Washington, the parent or guardian may submit an application in one of the following ways:
- Online with the Washington Healthplanfinder at www.wahealthplanfinder.org.
- Over the phone by calling the Customer Support Center at 1-855-WAFINDER (855-923-4633) or 1-855-627-9604 (TTY).
- By mail to:
PO Box 946
Olympia, WA 98507
In-person application assistance is also available. To get information about in-person application assistance available in their area, the parent or guardian may visit www.wahealthplanfinder.org
or call the Customer Support Center.
Jim Harvey, Ed.S, Program Specialist
School-Based Healthcare Services for Children in Special Education
Health Care Services
Health Care Authority
New One-Stop Provider website: https://fortress.wa.gov/dshs/p1contactus/
For urgent issues, you can call the Medicaid Customer Service Center at 1-800-562-3022.
The phone hours are: Monday through Friday 7:30 a.m. to 4:30 p.m.