Simplify SMP


Simplify SMP™

In 1988, Congress passed Section 411(k)(13) of the Medicare Catastrophic Coverage Act to ensure that Medicaid would cover medically necessary health-related services provided to a child under the Individuals with Disabilities Education Act (IDEA) and specified in a child’s individual educational plan (IEP) or family support plan. The intent of Congress was to enable Medicaid and IDEA to be used together to meet the educational and health-related needs of children with disabilities. Some services on a student’s IEP or family support plan are educationally relevant and are also medically necessary, and thereby reimbursable by Medicaid. The 1995 Florida Legislature provided authorization, with revisions made in 1997 (ss. 236.0812, 409.9071, 409.908, 409.9122 and 409.9126, Florida Statutes), to the Florida Agency for Health Care Administration (AHCA) and the Florida Department of Education (DOE) to develop a category of school-based services termed the Medicaid Certified School Match Program to reimburse school districts for services provided to Medicaid-eligible students who qualify for services under IDEA, Part B or C. Under the Medicaid Certified School Match Program, school districts are reimbursed for the federal portion, or approximately 56 percent, of the Medicaid established reimbursement fee for medically necessary services covered under the program. Only school districts may enroll as providers and receive reimbursement under the Medicaid Certified School Match Program.