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Medicaid

A 1988 amendment to the Social Security Act provided statutory authority for SSHSP, also known as Medicaid in Education, by allowing Medicaid coverage of medically necessary services included in the Individualized Education Programs (IEPs) of students with disabilities. The purpose of SSHSP is to assist school districts, §4201 schools and counties obtaining Medicaid reimbursement for certain diagnostic and health support services provided to students with disabilities. The SSHSP applies to students with Medicaid coverage from age three years up to their twenty-first birthday.

In order for children to receive Medicaid reimbursable services under SSHSP/PSSHSP, they must be Medicaid eligible, be under the age of 21, have been determined to have a disability through the IEP process and have an IEP.

To qualify for reimbursement under New York State Medicaid, SSHSP services must be:

  • medically necessary and included in a Medicaid covered category (speech therapy, physical therapy, etc.)
  • ordered by a practitioner acting within his or her scope of practice
  • included in the student's Individualized Education Program (IEP)
  • provided by qualified professionals under contract with or employed by a school district; a §4201 school; an approved pre-school, a county in the State or the City of New York
  • furnished in accordance with all requirements of the State Medicaid Program and other pertinent state and federal laws and regulations, including those for provider qualifications, comparability of services, and the amount, duration and scope provisions, and
  • included in the State's Medicaid plan and/or available under Early Periodic Screening, Diagnosis and Treatment (EPSDT).

 

Medicaid Compliance Program

To report suspected fraud, waste, and/or abuse of the Medicaid Program, send a completed Medicaid Abuse Report Form to Helisse Palmore, Compliance Officer:
Pupil Personnel Building
1735 Hempstead Turnpike
Elmont, NY 11003
E-mail: hpalmore@elmontschools.org
Phone: (516) 326-5580 ext. 42237
All complaints should be in writing.