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Medicaid Billing Services

PREP provides billing support for the array of services which fall under Medicaid for students with a disability.  Parents consent for PREP to bill medicaid for services their child receives at school.  This does not effect any benefits received by the child and parent. 

Medicaid Eligibility

In order to be eligible for Medicaid, applicants must meet the non-financial and financial requirements for Medicaid and must be in one of the groups covered by Medicaid. The four major groups covered by Medicaid are:

  1. Medically Indigent Children and Pregnant Women (MI) - Medicaid generally provides coverage to pregnant women and children with countable family income below 133% of the federal poverty level (FPL) who meet the non-financial requirements. Eligibility under this component is determined without regard to the individual's resources.
  2. Low Income Families and Children (LIFC) - Medicaid covers families who meet the non-financial requirements and the income and resource requirements.
  3. Aged, Blind and Disabled (ABD) - Medicaid covers individuals over 65 and individuals with disabilities who meet the non-financial requirements and the income and resource requirements. Medicaid covers Supplemental Security Income (SSI) recipients who meet the resource requirements.
  4. Long-Term Care (LTC) - Medicaid provides coverage to individuals who require care in a medical facility or whose care can be provided in the home and whose income and resources are insufficient to cover the cost of their care. Coverage - For individuals who meet income and resource limits for full coverage, Medicaid covers a comprehensive range of services, including hospital care, doctor’s visits, prescriptions, mental health services, and rehabilitative services.

An individual may be covered by other health insurance and be eligible for Medicaid. Medicaid will cover the cost of care not covered by the other plan and may cover the cost of employer-sponsored health insurance for eligible individuals.

Medicare enrollees - Medicaid covers the Medicare premiums, copayments, and deductibles for individuals who are eligible for full Medicaid coverage and who also have Medicare. Individuals with Medicare Part A whose income and resources are over the limit for full Medicaid coverage may still be eligible for limited coverage.

Children’s health insurance - In Virginia, Children’s Health Insurance includes Medicaid and Family Access to Medical Insurance Security (FAMIS) and is available through a single application. Children will be covered by Medicaid if the family’s income meets the Medicaid income requirements. Children who are not eligible for Medicaid and who meet the FAMIS eligibility requirements will be covered by FAMIS.

More information may be obtained through your local Social Services Department or through the Virginia Department of Medical Assistance Program http://www.dmas.virginia.gov/.