Medical Assistance

Student Eligibility for Medical Assistance (MA)

Indicate YES or NO

MA Number

If the student is a recipient of Medical Assistance enter the student’s MA number.

Parental Consent for Service Coordination and Health Related Services

An IEP team determines that the recipient of Medical Assistance (MA) is a student with disabilities who:

• Is eligible for special education and related services; and
• Requires the provision of special education and health related services.

The student’s parent elects, on the student’s behalf, to receive service coordination and health related services as specified in the student’s IEP. In accordance with COMAR 10.09.52, the student’s parent is required to identify the MA Service Coordinator(s).

Each time the student’s IEP is reviewed or revised, a public agency or provider agency must provide parent(s) written notice of public benefits, in accordance with 34 C.F.R. §300.154(d)(2)(iv)(A)

Each time the student’s IEP is reviewed or revised, a public agency or provider agency must obtain written parental consent for the selection of the MA Service Coordinator.

In accordance with 34 C.F.R. §300.154(d)(2)(iv), parents are required to provide one-time only consent to access public benefits, after receiving written notice consistent with 34 C.F.R. §300.154(d)(2)(v),

By providing consent the parent understands and agrees in writing that the public agency may access their child’s Medicaid to pay for services provided to their child.

NOTE:
If the student’s parent refuses consent for MA service coordination or access to public benefits, the provider agency is not relieved of its responsibility to provide all required health related services at no cost to the parents.