SEMI (Special Education Medicaid Initiative)
Medicaid Annual Notification Regarding Parental Consent
2022-2023 School Year
Background: The State of New Jersey has participated in a Federal program, Special Education Medicaid Initiative (SEMI), since 1994. The program assists school districts by providing partial reimbursement for medically-related services listed on your child’s Individualized Education Program (IEP).
The SEMI program is under the auspices of the New Jersey Department of the Treasury through its collaboration with the New Jersey Department of Education and New Jersey Division of Medicaid Assistance and Health Services.
In 2013, the regulation regarding Medicaid parental consent for school-based services changed. Now the regulations require that prior to accessing a child’s benefits or insurance for the first time, and annually thereafter, school districts must provide parents/guardians written notification and obtain a one-time parental consent.
Is there a cost to you?
No. IEP services are provided to students while at school at no cost to the parent/guardian.
Will SEMI claiming impact your family’s Medicaid benefits?
The SEMI program does not impact a family’s Medicaid services, funds, or coverage limits. New Jersey operates the school-based services program differently than the family’s Medicaid program. The SEMI program does not affect your family’s Medicaid benefits in any way.
What type of services does the School-Based Services program cover?
- Evaluations
- Speech Therapy
- Occupational Therapy
- Physical Therapy
- Psychological Counseling
- Audiology
- Nursing
- Specialized Transportation
What type of information about your child will be shared?
In order to submit claims for SEMI reimbursement, the following types of records may be required: first name, last name, middle name, address, date of birth, student ID, Medicaid ID, disability, service dates and type of services delivered.
Who will see this information?
Information about your child’s special education program may be shared with the New Jersey Division of Medicaid Assistance and Health Services and its affiliates, including the Department of the Treasury and the Department of Education for the purpose of verifying Medicaid eligibility and submitting claims.
What if you change your mind?
You have the right to withdraw consent to allow for Medicaid billing at any time by contracting the school in which your child is enrolled.
Will your consent or refusal to consent affect your child’s services?
No. Your school district is still required to provide services to your child pursuant to his or her IEP, regardless of your Medicaid eligibility status or your willingness to consent for SEMI billing.
What if you have questions?
Please call your school district's Special Education Department with questions or concerns or to obtain a copy of the parental consent form.