NC Medicaid School Based Services
School-Based Medicaid Services (SBS)
North Carolina's school-based Medicaid program helps public schools get paid back for health services they already provide to students. Schools can bill Medicaid for care such as speech therapy, occupational and physical therapy, hearing services, nursing and mental health support. They can also claim for the work it takes to connect students to care. This site holds the policy, forms, and training your school needs to take part. Use the contacts below to reach the Division of Health Benefits, or join our email list for updates.
DHB (the Division of Health Benefits) maintains a help email address (Medicaid.SchoolBasedServices@dhhs.nc.gov) schools can reach out to if they have questions. All inquiries are jointly reviewed by DHB and DPI.
If you would like to receive email updates about the school-based Medicaid program, please access the sign-up sheet (coming soon).
DHB requires each PSU to have a primary contact for the school-based Medicaid program and a back-up for that person. If PSUs need to update their contact person or back-up, they can complete the contact form (coming soon).
DPI also provides consultants to schools to support the provision of services. If you have questions specific to these scopes of practice, please reach out to these consultants:
- School Social Work Consultant – Pachovia Lovett
- School Counseling Consultant – Kisha Bryant
- School Nurse Consultant – Jennifer Corso
- School Psychology Consultant – Megan Cardin
- Consultant for Occupational Therapy – Bridgette LeCompte
- Consultant for Physical Therapy – Laurie Ray
- Consultant for Psychological Services – Lynn Makor
- Consultant for Speech-Language Services – Perry Flynn
This site is in the process of adding additional materials and resources.
Resources
Start here. The school-based Medicaid toolkit walks you through the program from end to end: who can bill, what is covered, how to write up services, and how payment works. Download the whole toolkit or just the section you need. Questions and answers and short online courses are also here to help new staff get up to speed.
- Full downloadable toolkit – coming soon
- Toolkit available by section – coming soon
- FAQs – coming soon
- Online courses for toolkit – coming soon
These are the official documents that set the rules for the program in North Carolina. Clinical Coverage Policy 10C lists covered services and who may provide them. The Time Study Implementation Plan, the Medicaid State Plan pages, and the fee schedule show how time studies work and how payment is set. When you need to be sure of a rule, look here first.
- 10C – coming soon
- Time Study Implementation Plan – coming soon
- Most current SPA – coming soon
- LEA Fee Schedule – coming soon
Federal rules shape what North Carolina can cover and pay for. This section links to the 2023 CMS guide to school-based services, joint guidance from the U.S. Department of Education on student records and privacy, and the federal technical assistance center. Use these when you want the source behind a state policy.
Before a school bills Medicaid for a student's services, federal law says the school must have written consent from a parent. Families must also get a notice once a year. Billing Medicaid costs families nothing and does not use up their child's benefits. Use the sample consent form and notice here, and share the parent questions and answers with families.
- Sample consent – Coming Soon
- Parent FAQ – Coming Soon
Related service providers give most school-based Medicaid care. This includes speech-language pathologists, occupational and physical therapists, audiologists, nurses, psychologists, counselors and social workers. This section covers what each provider type can bill, the license and supervision rules that apply, and what records to keep. You will also find who to contact at the state for each service area.
Schools get payments during the year, then file a cost report that shows what services really cost. The cost report settles the difference between what was paid and what was spent. Here you will find the cost report, step-by-step instructions and guidance on how schools can use Medicaid funds.
- Cost Report – coming soon
- Cost Report Instructions – coming soon
- Using Medicaid funds – coming soon
A school must enroll as a North Carolina Medicaid provider before it can bill. Some staff who order or give services must enroll as well. This section explains who needs to enroll, what each step asks for and where to apply.
- PSUs – coming soon
- Providers – coming soon