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 a parent’s public or private insurance proceeds to provide FAPE to an eligible student only if the parent provides informed consent to the district. Whenever the district proposes to access the parent’s public benefits or private insurance proceeds, the district shall:
- Obtain parent consent in accordance with Chapter 392-172A WAC each time the district uses 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.
- To avoid financial cost to parents who would otherwise consent to use private insurance, or public benefits if the parent 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.
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