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Medicaid, SHARS, The District and You

 

Dear Parents,

In an effort to provide the best services possible, your school district has been approved as a provider for School Health and Related Services (SHARS) for their participation in the Texas Medicaid program. Over the years, this proven, confidential program has provided millions of dollars to assist school districts across the state. If your child or children are currently covered through Medicaid, we will be able to obtain funding for the school from Medicaid for providing your children any of the following services, as determined by the Admission, Review and Dismissal (ARD) committee and as stated in your child’s Individual Education Plan (IEP):

Assessment, Audiology, Counseling, Medical Services, School Health Services, Occupational Therapy, Physical Therapy, Psychological Services, Speech—Language Therapy, Special Transportation and Personal Care.

As a parent you have the right to choose a provider other than the school district; however, the provider you choose must be an approved SHARS provider. An approved provider may be the school, another agency, person or organization qualified to provide the services required for your child.

 

 

 

The following Frequently Asked Questions and Answers will give you some background on the SHARS program and how it affects your child and the school district.

Q:What is the SHARS program?

A:The SHARS (Texas Medicaid) program is a Federally funded program run by Medicaid. This program allows Texas school districts to be reimbursed for health-related services they provide to children with Medicaid.The Federal Medicaid program will pay approximately 56% of the costs of these services for eligible students.


Q:How does Parental Consent factor into SHARS?

A:As of March 18, 2013, the US Dept of Education passed a law stating the school districts' Special Education departments must provide the parent/guardian with annual notification to bill Medicaid once informed written consent has been obtained. Informed written consent to bill Medicaid is still required; however, it is only required one time prior to billing for SHARS Medicaid reimbursement. Districts are no longer required to obtain written parental consent each time the district wishes to bill for Medicaid. Even if the services change, districts do not need to acquire new written consent.


Q:Will the money collected go directly to my child?

A:No. The money will be paid to the school district who is the “provider” of the health-related services. Indirectly, of course, this new source of funding will help ALL children and reduce local tax payers costs. It is typically used to help the school purchase items that students need.


Q:Are there other forms and paperwork to fill out?

A:No. All other paperwork will be handled by the school and Texas State Billing Services. The only paperwork required by the parent is the initial informed parental consent agreement. Once the consent form is signed the first time, the school district will inform you each subsequent year that they will be billing for your child’s service(s), at which time you have to option to withdraw your consent.


Q:Will this program affect my child’s regular Medicaid coverage?

A:No. The School Medicaid program is completely separate from the Medicaid program that covers your child’s normal Medicaid expenses.


Q:My child does NOT have Medicaid Health Insurance, but I'd like more information about Medicaid. What do I do?

A:We have listed the phone number for Medicaid Health Insurance information in this brochure.This office can confidentially tell you whether or not your child could be eligible.
NOTE: If your child receives free or reduced lunch at school, he or she may qualify for Medicaid Insurance.


Q:Is our family’s income the only criteria for Medicaid coverage?

A:No. The “Katie Beckett” program provides coverage for children with severe disabilities who are being cared for at home. If a child meets the medical criteria for this program, the income of the parents is not considered in determining eligibility for Medicaid.

 

Third Party Liability for SHARS Interim Claims

This policy change referenced below only applies to parents/guardians whose child is on Medicaid and is also covered by private insurance.

  • As of October 1, 2017, Texas Medicaid changed its Third Party Liability policy to use the “pay and recover later” method.
    • This method for SHARS means that Medicaid pays the school district and then may seek reimbursement from a third party (like private insurance held by parents of a student with a disability) if available.
    • If the third party denies the claim for an acceptable reason, no additional action is taken
    • The third party will deny the claim in most cases.
  • Parents will not incur out-of-pocket expenses as a result of this policy
    • This is because Texas Medicaid pays copayments and deductibles associated with private insurance for SHARS services.
    • Due to the free and appropriate public education requirements, parents cannot be charged for special education services.
  • If a parent or guardian believes they received an insurance bill for SHARS services, it may simply be an Explanation of Benefits (EOB).
    • This EOB will likely contain statements similar to “What I Owe: $0.00,” and, “This is not a bill.”
  • If a parent does receive an actual bill for SHARS services from his/her insurance company, they should call TMHP at 1-800-925-9126.
  • TSBS will continue to monitor any additional communication and clarification from State of Texas Agencies regarding this policy change.
  • Neither we nor the state agencies we have contacted anticipate any negative effects to parents, students, school districts or the SHARS program itself.
  • No changes to consent forms or distribution of documentation are required

 

 

Your school’s Medicaid reimbursement program is being administered by TSBS.TSBS has over 20 years of experience in the area of Medicaid reimbursement and is considered an expert in this field. TSBS has developed an efficient and confidential Medicaid administration program that school districts in Texas have come to rely on.TSBS is dedicated to making sure that parents have full knowledge of the SHARS program and many of the benefits for schools across Texas.

For more information about how the SHARS program may benefit your school or your child, please contact TSBS with the information listed below.



 


Third Party Liability for SHARS Interim Claims

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