Question:       Are there limits to a school system’s ability to access a child’s Medicaid or other public insurance to pay for services required to be provided under the Individuals with Disabilities Education Act?

Answer:         Yes. The new (March 12, 1999) regulations implementing IDEA explicitly address this issue.

            Unlike the case in the use of private insurance, schools do not have to obtain informed consent from a parent before tapping a child’s Medicaid or other public insurance. See 64 Fed. Reg. 12406,12430 (March 12, 1999) (to be codified at 34 C.F.R. §300.142(e)). However, before doing so, the school system must ensure sure that tapping the child’s public health benefits will not (1) decrease available lifetime coverage or any other benefit; (2) result in the family paying for services that the child needs outside of school, and that otherwise would be covered by the public insurance program; (3) increase premiums or lead to discontinuation of the insurance; or (4) risk loss of eligibility for home and community-based waivers, based on total health-related expenditures. 64 Fed. Reg. at 12430 (to be codified at 34 C.F.R. §300.142(e)(2)(iii)).

            Furthermore, school officials may not require parents to sign up for Medicaid or other public insurance as a condition for their child receiving services under IDEA. 64 Fed. Reg. at 12430 (to be codified at 34 C.F.R. §300.142(e)(2)(i)). Nor may they require parents whose children are enrolled in public insurance programs to incur any out-of-pocket expenses, such as paying a deductible or co-payment. 64 Fed. Reg. at 12430 (to be codified at 34 C.F.R. §300.142(e)(2)(ii)).