Parental Consent to Share Information and Access Medicaid

The Ohio Medicaid School Program

The Newark City School District has the opportunity to receive Federal Medicaid dollars through a program called the Medicaid School Program (MSP). Through this program, school districts can receive Medicaid dollars for services such as Speech, Audiology, Physical Therapy, Occupational Therapy and Psychology services. The district can receive Medicaid funding when a student receives one or more of these services and the student has current Medicaid insurance coverage. In the process of billing Medicaid for these services, certain billing information must be shared with the Ohio Department of Jobs and Family Services. Before the district can submit claim data for Medicaid billing purposes, we must first obtain a signed Parental Consent to Share Information and Access Medicaid Form.

Your consent is voluntary. You have the right under 34 CFR Part 99 and Part 300 to withdraw your consent at any time. You are not required to enroll in Medicaid. Billing Medicaid will not require you to incur any out-of-pocket expenses such as a deductible or co-pay, decrease lifetime coverage, increase premiums or lead to the discontinuation of benefits, or result in you paying for services that would otherwise be covered by Medicaid. No matter whether you grant consent, refuse consent, or revoke consent, your child will be provided with an evaluation and/or the services listed in their IEP at no cost to you.

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