What if my child is Medi-Cal eligible?

The following information about Medi-Cal is provided for parents of children with disabilities who are Medi-Cal eligible. As per the Individuals with Disabilities Education Act (IDEA) regulations, the Tri-Valley SELPA provides all required services as specified on a child’s IEP at no cost to parents. However, your District can be reimbursed for the cost of those services from the Federal government’s Medicaid program, which increases the ability to provide health-related services for all Tri-Valley SELPA students.

The cost of providing health-related services is high. Federal education funds only cover a fraction of the expenses. In 1986, Congress authorized schools to bill the Medicaid (note: in California, Medicaid is called Medi-Cal) program for certain health-related services. Many children and families who do not have other health insurance benefit from the services provided and supported by Medi- Cal funds in schools. In the case of students with disabilities, school-based health care is an efficient and effective mode of health care delivery. It saves parents the time and effort needed to travel between different clinics and hospitals for these services.

Services reimbursed by Medi-Cal currently include certain health services for all students in the District as well as specific services for students with disabilities. The health-related services for students with disabilities include both assessment and the treatment(s) specified on a student’s Individualized Education Program (IEP) including audiology, counseling, nursing services, occupational therapy, physical therapy, speech therapy, and transportation related to these services. Medi-Cal regulations set the same high professional standards for school-based providers as providers who work in hospitals, rehabilitation centers, and other settings.

Parents of students who are Medi-Cal eligible authorize their District to submit claims for reimbursement by Medi-Cal for Medi-Cal funded services when a parent signs for consent on a Special Education Assessment Plan or an IEP. The frequency of claims is aligned with assessment authorizations and/or the type and frequency of the Medi-Cal funded services a parent authorizes on the student’s IEP. In seeking reimbursement, your District may need to release student records, medical information, and/or other information pertaining to a student. School-based Medi-Cal reimbursement does not affect the child’s Medi-Cal benefits in other health care settings. There is no cap on Medi-Cal for students with disabilities in California.

The Tri-Valley SELPA never bills a family’s private insurance for the health care services specified on a child’s IEP. The Districts adhere to IDEA and its requirement to provide students with disabilities with a free and appropriate public education (FAPE). Parents of students who are Medi- Cal eligible authorize their District to submit claims for reimbursement by Medi-Cal for Medi-Cal funded services unless Parent(s) signs a Parent Medi-Cal Non-Authorization to Bill form.

Children qualify for Medi-Cal based on various factors including family income and disability. Parents interested in obtaining more information about Medi-Cal should check with their primary health care provider.