Most state IDEA systems access Medicaid to cover IDEA direct services and some to cover infrastructure costs. Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements under the US Department of Health and Human Services. The program is funded jointly by states and the federal government. The federal share or Federal Medical Assistance Percentage (FMAP) varies by state and is based on the state's per capita income. States with lower per capita income typically have a higher FMAP reimbursement for their total Medicaid expenditures.
The Centers for Medicare & Medicaid Services (CMS) is the federal entity responsible for implementing laws passed by Congress related to Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program.
CHIP is a public health insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women.
The medicaid.gov website contains a searchable database of state-specific information including program documents such as state plan amendments, demonstrations and waivers, and managed care profile.
Early Periodic Screening Diagnosis and Treatment (EPSDT)
- Connecticut's Story: Using a State Plan Amendment to Expand Medicaid for Early Intervention Services under EPSDT
- EPSDT and Title V Collaboration to Improve Child Health EPSDT: The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is the child health component of Medicaid. It's required in every state and is designed to improve the health of low-income children, by financing appropriate and necessary pediatric services. This website provides information about how EPSDT works with public health, families, managed care organizations, pediatricians, and other health providers.
- Accessing EPSDT for Part C Services (2011)
- Considerations When Accessing Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT) for Part C Services (2010), ITCA
- Texas EPSDT Developmental Rehabilitation Services includes diagnostic, evaluative and consultative services for the purposes of identifying or determining the nature and extent of and rehabilitating an individual's medical or other health-related condition.
A Medicaid waiver is when the Federal Government allows or grants States permission to waive certain Federal requirements to operate a specific kind of program. In general, Federal law allows States to enact two types of Medicaid waivers: Program waivers and research and demonstration waivers.
Program Waiver: Home and Community Based Waivers
- Maryland: Services for autistic children and seriously emotionally disturbed individuals.
- North Dakota: ND Traditional Intellectual Disabilities and Developmental Disabilities HCBS Waiver (0037.R08.00) provides behavioral consultation, environmental modifications, equipment and supplies, family care option, in-home supports, infant development, parenting support services for individuals with intellectual disabilities and developmental disabilities ages 0 to no max age.
- Pennsylvania: PA Medicaid Waiver for Infants, Toddlers and Families (0324.R05.00) provides special instruction for individuals with intellectual disabilities and developmental disabilities ages 0-2.
- Wisconsin: Payment by Medicaid for eligible children when use of private insurance is denied by the parent.