Official State of Rhode Island website

The Executive Office of Health and Human Services State of Rhode Island

Local Education Agency

The Executive Office of Health and Human Services developed the RI School-Based Medicaid Direct Services Guidebook to assist schools and districts in Rhode Island to bill Medicaid for reimbursement of Medicaid-eligible services provided to Medicaid enrolled students by or for Local Education Agencies (LEAs) and the RI School-Based Medicaid Administrative Claiming Guide to assist schools and districts to bill Medicaid for reimbursement for administrative costs associated with the provision of direct services, such as those incurred for outreach, enrollment assistance, and coordination of activities.  

RI School-Based Medicaid Administrative Claiming Guide (January 2020) 

  • This guide provides information about appropriate methods for claiming federal reimbursement for the costs of Medicaid administrative activities performed in the LEAs (such as outreach and enrollment, translation, transportation, referral and coordination of care, and Medicaid-related training) including: interagency agreements (LEA contracts), time study requirements, operational principles, documentation guidelines, program integrity, claim submission (such as, activity definitions and codes and cost calculations), and other policies and regulations. 

RI School-Based Medicaid Direct Services Guidebook (September 2020) 

  • This guidebook includes information on Medicaid provider enrollment, service definitions, provider qualifications, documentation guidelines, claim submission information (including diagnosis and procedure codes), claim reconciliation information, eligibility verification, and other policies and regulations.     

RI School-Based Medicaid Direct Services Guidebook Section IX: Addenda A-T (September 2020)  

LEAs are responsible for maintaining records used to support claims submitted for Medicaid reimbursement.  They also administer procedures to ensure program integrity. 

To speak with a Provider Representative about Medicaid reimbursement for LEA Services, please find contact information on the LEA Provider webpage.  

For all other questions, please email EOHHS School-Based Medicaid Program Manager at OHHS.LEAMedicaid@ohhs.ri.gov.