Students Covered by Public or Private Insurance
The district may use Medicaid or other public insurance benefits programs in which a student participates to provide or pay for services required to provide a FAPE, as permitted by the public insurance program. However, the district shall not:
- Require parents to sign up for or enroll in public benefits or insurance programs in order for their student to receive FAPE under Part B of the IDEA;
- Require parents to incur an out-of-pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim;
- Use a student's benefits under a public insurance program if that use would:
- Decrease available lifetime coverage or any other insured benefit;
- Result in the family paying for services required after school hours that would otherwise be covered by the public insurance program;
- Increase premiums or result in discontinuation of insurance; or
- Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.
The district may access parents' public or private insurance proceeds to provide FAPE to an eligible student only if the parents provide informed consent to the district. Whenever the district proposes to access the parent’s private insurance proceeds, the district shall:
- Obtain parent consent in accordance with Chapter 392-172A WAC each time the district wishes to access benefits for a new procedure; and
- Inform the parents that their refusal to permit the district to access their insurance does not relieve the district of its responsibility to ensure that all required services are provided at no cost to the parents.
Before first accessing parents' or students' public benefits, for the first time and annually after the first notification, the district will provide written notification using the prior written notice provisions under WAC 392-172A-05010(3) that include:
- A statement of the parental consent provisions;
- A statement of the "no cost" provisions;
- A statement that the parents may withdraw their consent to disclose personally identifiable information to the agency responsible for administering the stat's public benefits or insurance; and
- A statement that a parents' withdrawal or refusal to consent does not relieve the school district of its responsibility to ensure that all required services are provided at no cost to the parents.
After providing the required notification, the district will obtain written informed consent from the parents allowing the district to disclose information from the student’s educational records to the agency responsible for administering the state’s public benefits or insurance programs. The consent will specify:
- The personally identifiable information that may be disclosed, such as records or information about the services that may be provided to the student;
- The purpose of the disclosure;
- The agency to which the disclosure will be made; and
- That the parents understand and agree that the public agency may access the parents’ or student’s public benefits or insurance to pay for services under the act.
To avoid financial cost to parents who would otherwise consent to use private insurance or public benefits if the parents would incur a cost such as a deductible or co-pay, the district may use its Part B funds to pay the cost the parents would incur.
*See the Special Education Terms & Definitions page for more information.