"Financing Related Services"
A survey of all states' directors of special education, Medicaid, and public health was intended to determine the extent to which "external" (public health, Medicaid or other health care funds) were used to pay for related services to children in Special Education. The study, while recently reported, relied on 1993-94 funding reports (which were the most complete across the states).
The average annual cost for a special education student was reported at just under $5000, but only 24 states could even estimate the cost of related services within that expense. For those, the related services cost averaged about 20%, or $1000 per pupil.
The average annual cost for a special education student was reported at just under $5000, but only 24 states could even estimate the cost of related services within that expense. For those, the related services cost averaged about 20%, or $1000 per pupil.
Twenty-nine states (80% of those responding) reported funding from Medicaid, and another ten states were developing the mechanisms to access such. Only six states reported public health funds contributed to related services, and those were typically for school nursing services. Georgia and New Jersey reported specific public health programs that directly assist students with disabilities. One state formally arranged to access private insurance for very high-cost cases, but some states' respondents cited concerns such as impact on a child's lifetime insurance benefits. Generally, all states relied on education funds for related services, and generally only 1-3% of the cost of related services came from external sources, with none externally funded more than 25% of the total cost.
The differences among states in the number of local districts meeting eligibility requirements for Medicaid reimbursement and the percentage of districts actually pursuing Medicaid reimbursement were related to: 1) having a formal state interagency agreement between the education agency and Medicaid, 2) having specific eligible personnel for related services, and 3) using school nursing services as a Medicaid service. No relationship was found between Medicaid use and other special education factors.
Among the states that submit billings to Medicaid for related services, there was great variability in billing and reimbursement practices. A simple billing method did not yield greater funding. The authors recommended that local schools improve their accounting of expenditures for related services. Likewise, state officials need to know how education and Medicaid funds received by schools are being used. In context, the 1975 federal legislation (Education of All Handicapped Children) included a plan to increase the federal share of the expense from 5% of the per pupil cost in 1978 to 40% by 1982, but federal allocations were only 8.2% as of 1993.
(Rodman J et al. A nationwide survey of financing health-related services for special education students. J Sch Health 1999;69(4):133-139)
Comment: We know more states and schools are presently billing Medicaid, but the nurses' ability to articulate the "value" to education administration and boards is hampered if school officials cannot promptly account for actual costs of related services as part of annual budget decision making. -J.O.
