What is SHARS:
School Health and Related Services (SHARS) is a state Medicaid program that allows school districts to receive reimbursements for certain health-related services provided to students in special education that are documented in a student's Individualized Education Program (IEP).
The requirements for Medicaid reimbursement:
- The student is under 21 years of age.
- The student must be Medicaid-eligible at the time of the service.
- The student must be enrolled in a public school's special education program.
- The service(s) the student receives must be documented in the students Admission, Review, Dismissal/Individual Education Plan (ARD/IEP).
- Covered Services must be provided by qualifying personnel who are under contract with/or employed by Kennedale ISD.
Will the SHARS program affect the students regular Medicaid coverage?
No, the Medicaid services the child receives at school does not affect or compromise the type or amount of Medicaid services a child receives outside of school.
Could billing SHARS cause a child to exceed any "cap" or lifetime maximum on their Medicaid benefits?
There is no lifetime benefit cap for Medicaid services to children under 21 years of age. SHARS is a program under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Under EPSDT, there are no set limitations on Medicaid services to clients under 21 years of age, so long as the service is medically necessary.
Is it required to obtain parental consent in order for the district to bill Medicaid under the SHARS program?
Yes, the district is required to obtain an initial one-time consent form from parents/guardians. Once consent is obtained you will receive an annual notification about the program at every annual Admission, Review, and Dismissal (ARD) meeting.
Do I have to sign the consent form if my child does not qualify for Medicaid?
We ask that all parents/guardians who have a student in special education sign the SHARS consent form since students often transition in and out of qualifying for Medicaid. However, you are not required to provide consent.
What happens to the money that is reimbursed to the district for SHARS?
The revenue received from SHARS will go into the district's general fund. All Kennedale ISD students will benefit from funds received from SHARS reimbursement.
The policy below only applies to parents/guardians whose child has Medicaid and private insurance.
Notifications: Third Party Liability (TPL)
The Texas Medicaid policy uses the “pay and recover later” method for SHARS which means that Medicaid pays the school district for services before third party reimbursement is sought. If the third party insurance denies a claim for an acceptable reason, no further action is taken. Medicaid has already paid and the parent is not responsible for any additional costs. Parents or guardians will not incur out-of-pocket costs as a result of this notice, because Texas Medicaid pays copayments and deductibles associated with private insurance. Lifetime benefits of private insurance could be affected depending on the policy or agreement parents or guardians have with the insurance company. However, as of the distribution date of this notice, Texas Health and Human Services (HHSC) has no evidence that this has occurred. At this time there are Local Education Agencies (LEA) addressing this issue with TEA and HHSC and as updates become available we will post them on the Kennedale ISD SHARS website.
For more information, call the TMHP Contact Center at 1-800-925-9126.
Distribution Date: 09/10/2018