School Based Claiming Program

The School Based Claiming program offers reimbursement for both the provision of covered medically necessary school-based services (Direct Service Claiming) and the costs of administrative activities (Medicaid Administrative Claiming), such as outreach, which supports the Medicaid school-based program. AHCCCS contracts with Public Consulting Group (PCG) Education to administer the program statewide. This program serves about 30,000 Arizona Medicaid eligible students.

Arizona Medicaid School-Based Claiming Program

Arizona participates in two Medicaid reimbursement programs for school based services, the Direct Service Claiming (DSC) program and the Medicaid Administrative Claiming (MAC) program. These two school-based programs assist participating school districts, referred to as Local Education Agencies (LEAs), including charter schools and the Arizona School for the Deaf and Blind (ASDB), by reimbursing them for their costs to provide Medicaid covered services to eligible students. The purpose of the DSC Program is to allow LEAs to receive reimbursement for the cost to provide Medicaid covered medical services to Title XIX eligible students. The purpose of the MAC program is to allow LEAs to receive reimbursement for Medicaid administrative outreach activities that are done routinely within the school setting. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that oversees these two school-based programs. In Arizona, these programs are overseen by the Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency. AHCCCS contracts with a Third Party Administrator (TPA), PCG, to administer both the DSC and MAC programs.

Role of AHCCCS

AHCCCS is Arizona’s Medicaid Program that was developed as a result of Title XIX of the Social Security Act. While AHCCCS also administers other state and federal health care programs, only Title XIX members are eligible for the DSC Program. The Medicaid Administrative Claiming (MAC) program is one of the two federally funded programs endorsed by the Arizona Department of Education (ADE) and AHCCCS. AHCCCS is the agency that develops the policies and administers the Medicaid School Based Claiming Program through PCG and in collaboration with the ADE.

Contracting with Public Consulting Group (PCG)

In order to become contracted with PCG, a LEA must:

  • Be an Arizona public school district or an Arizona charter school
  • Have students eligible under the Individuals with Disability Education Act (IDEA)
  • Provide one or more of the Medicaid covered services on site
  • Sign an agreement with PCG

The agreement details the responsibilities and rights of both PCG and the participating LEA and the services to be provided to the LEA. The completed contract allows the LEA to participate in the Medicaid School Based Claiming Program administered by PCG. On receipt of the signed contract, PCG will work with the LEA to implement the Medicaid claiming processes.

For more information, visit Public Consulting Group’s website, at: https://web.pcgus.com/

Medicaid School Based Claiming FAQs