Medicaid (SHARS) Information
Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as School Health and Related Services (SHARS). The oversight of SHARS is a cooperative effort between the Texas Education Agency (TEA) and Health and Human Services Commission (HHSC). SHARS allow local school districts to obtain Medicaid reimbursement for certain health-related services documented in a student's Individualized Education Program (IEP). SHARS providers are reimbursed the federal share of the established reimbursement rate. School districts receive federal Medicaid money for SHARS services provided to students who meet all three of the following requirements. These students must:
- Be Medicaid eligible,
- Meet eligibility requirements for Special Education described in the Individuals with Disabilities Education Act (IDEA), and
- Have Individualized Education Program (IEP) that prescribe the needed services.
Current SHARS services include: assessment, audiology, counseling, school health services, medical services, occupational therapy, physical therapy, psychological services, speech therapy, special transportation and personal care services. These services must be provided by qualified professionals under contract with or employed by the school district. Furthermore, the school district must be enrolled as a Medicaid provider in order to bill Medicaid.
If a child receives Medicaid billable services at school under the SHARS program, are they also able to receive the same service through Medicaid outside of the regular school hours?
Yes, the child’s eligibility for Medicaid services outside the school setting is not compromised by receiving SHARS services at school. The services provided at school are so the child may receive a free and appropriate public education. Due to medical necessity, the child may need additional services outside of school. For example, a school may provide and bill for SHARS speech therapy for a student who also receives Medicaid THSteps-CCP speech therapy outside the school.
Could billing SHARS cause a child to exceed any “cap” or lifetime maximum on their Medicaid benefits?
There is no lifetime benefit cap for Medicaid services to children under 21. SHARS is a program under the EPSDT (Early and Periodic Screening, Diagnosis and Treatment) program. Under EPSDT, there are no set limitations on Medicaid services to clients under 21, so long as the service is medically necessary. The Medicaid services the child receives at school do not affect the type or amount of Medicaid services the child received outside of the school.
Is it required to obtain parental consent in order for the district to bill Medicaid under the SHARS program?
Yes, Section 300.154(d) of the reauthorized IDEA 2004 requires districts to obtain informed parental consent. Schools should obtain informed parental consent to bill Medicaid for the specific services and the frequency as outlined in the child’s current ARD/IEP. You will receive notification at every annual Admission, Review and Dismissal (ARD) about the program and will require you to sign a parental consent letter.
Parents please know that:
- Billing Medicaid is not a new process
- SHARS is reimbursement money to the schools. Your child’s ability to receive services outside of the school setting will not be impacted
- SHARS is a program under EPSDT (Early and Periodic Screening, Diagnosis and Treatment) and is not subject to any type of limit or “cap” on services
- You can withdraw permission at any time
What if I have questions? Contact the Special Education Office at 903-891-6439