New Hampshire Application for Expansion of Medicaid School-Based Services Program (Medicaid to Schools) - The Hampshire Department of Health and Human Services (DHHS) is requesting $2.5 million in funding from the Centers for Medicare and Medicaid Services in order to modernize the State’s Medicaid to Schools (MTS) program. New Hampshire will utilize the funds to contract with a vendor to provide intensive technical assistance to local education agencies (LEAs) throughout a planned transition from the current in-kind methodology to a Certified Public Expenditure (CPE) methodology. The selected MTS vendor will provide a unified data system for billing and claiming and provide technical assistance to schools through staff, a call center, and provision of trainings and training materials. The dedicated technical assistance that a contracted vendor can provide will exceed what the state’s current capacity is to provide needed supports to New Hampshire’s LEAs. Many of the NH LEA staff responsible for MTS administration and billing are conducting those responsibilities in addition to other existing duties. Moreover, understandably because of their myriad other obligations, many have limited knowledge of State and Federal regulations surrounding Medicaid billing, medical necessity, documentation, licensure, scope of practice, and supervision standards that are integral to successfully engaging as a provider with Medicaid. The LEAs rely heavily on third-party billers to support their participation in the Medicaid to Schools program. LEA must shoulder all of these duties: obtaining relevant data from the state special education information system, monitoring providers for compliance with IDEA and Medicaid interagency coordination requirements as well as IDEA and Medicaid notice and parental consent requirements, supplying sufficient and compliant documentation, and interfacing with MMIS. Shifting to a CPE methodology for federal claiming will permit the program to reach its full potential. NH is looking both to continue to access the financial resources its public schools use to offset the cost of services provided to students with IEPs and to maximize the program’s potential to reinforce school resources that will allow NH schools to continue to provide covered healthcare services to eligible students. Federal reimbursement for the NH MTS program is relatively low, with an annual approximate spend of $13m annually over the last several years. This is a small component of New Hampshire’s $2.5b annual spend. New Hampshire has a robust enrollment rate of LEAs; eighty percent (80%) of those LEAs are actively billing Medicaid. However, the active billing does not necessarily reflect the amount of Medicaid enrolled students in the region. Point in fact, the county with the lowest Medicaid to Schools billing rate, Coos County, which has only 45% of its school districts billing MTS, has the highest percentage of its population enrolled in Medicaid of all New Hampshire counties. In other words, it is likely that NH LEAs are not maximizing the Medicaid reimbursement for which they are already eligible. New Hampshire Medicaid to Schools must shift to a CPE methodology by June of 2026. Contracting with a vendor to provide a higher level of technical assistance and support to its LEAs throughout this transition to ensure LEAs can maximize the Medicaid resources available to them and the children they serve.
