Forms and Letters
Medicaid Consent Form
The New York City Department of Education (DOE) asks that all families of students with disabilities sign a Medicaid Consent Form. This form allows us to access the records (for example: IEP, progress notes) needed for claiming Medicaid reimbursements, as well as to access a family’s Medicaid information if applicable. We work to get this form from all families of students with disabilities, regardless of their individual Medicaid status. The DOE never shares Medicaid eligibility information with schools or service providers, and is committed to providing services per a student’s IEP—whether or not the form is signed.
Once a family has consented and returned the signed Medicaid Consent Form, it is valid for all future years their child is enrolled in the DOE.
Personalized Medicaid Consent Forms can be generated by a student’s school and returned there as well.
Medicaid Annual Written Notification
Annual Written Notification of intent to continue seeking reimbursements will be given to families that have previously signed a Medicaid Consent Form. If a family has previously signed a Medicaid Consent Form the written notice will be provided to the families annually.
Medicaid Consent and CIN Collection Portal
Families, please use this secure web portal to:
- electronically sign a Medicaid Consent form
- share your student’s Medicaid Client Identification Number (CIN) with us
You will need to know your student’s NYC Student ID number in order to access the portal. It is the 9-digit number on your child’s report card.
Contact the Office of Medicaid Operations
Phone: 855-740-5928 (toll free)
The Office of Medicaid Operations is responsible for the facilitation of efforts to claim Medicaid reimbursements of related services for applicable areas including:
- Physical Therapy,
- Occupational Therapy, and
- Speech/Language Therapy.
The office works to ensure that claims submitted by the DOE meet State and federal requirements.
Frequently Asked Questions
Can I change my mind after I have signed a consent form?
Yes. You can change your mind at any point. Contact your child’s school and ask that they print a new Medicaid Consent Form for your child. You can fill that new form out and return it to your child’s school.
My family is not Medicaid eligible—do I need to complete the form?
The DOE asks all families of students with IEPs to complete this form, regardless of their Medicaid eligibility status. The form does not ask a family to identify their Medicaid eligibility status.
Will signing the form impact my family’s Medicaid benefits? Are there any costs to me or my family?
No. Signing the form will not impact a family’s Medicaid benefits. There is no cost to you or your family. There are no expenses, premiums, costs, or co-payments. If your family receives Medicaid benefits, your coverage will not be canceled, the lifetime coverage in place will not decrease, and services that your family receives will not be affected in any way by the accessing of Medicaid benefits. You will not risk the loss of eligibility for home and community-based waivers, if any, that are based on your total health-related expenditures.
Will my child’s IEP related services be impacted if I do not sign the form?
No. The consent form has no impact on service provision to your child. The DOE is obligated to provide the services on the IEP regardless of whether or not there is a signed Medicaid Consent Form. You will not be asked to sign up for or enroll in Medicaid for your child to receive the services on his/her IEP.
Medicaid Compliance Officer
The DOE Medicaid Compliance Officer is responsible for the day-to-day management of the DOE's efforts to prevent, detect, and correct fraud, waste, and abuse in connection with the Medicaid in Education program. This includes oversight of the DOE Medicaid Compliance Plan, ensuring that Medicaid-related activities meet federal, state, and local requirements, along with providing Medicaid compliance training to relevant employees and contractors.
Confidential Medicaid in education fraud and abuse toll-free hotline: 877-393-5432
The Medicaid Compliance Officer maintains a toll-free confidential hotline where suspected fraud and abuse can be reported.
A Duty to Report
The Medicaid in Education program permits the DOE to obtain much needed Medicaid reimbursement for certain diagnostic and health support services provided to students with disabilities. We are individually and collectively responsible to report suspected violations of federal and state laws governing this program. We need your help to ensure that program rules are followed.
What to Report
Any activity by the DOE (or a DOE employee or contractor) that violates Medicaid laws or regulations, including:
- Claiming or verifying attendance for related services that were not provided
- Double billing (a contractor or independent provider bills both the DOE and Medicaid for the same related services)
- Documenting/claiming for related services at a higher rate when a lower rate service was provided (documenting/billing for one-on-one when a group service was provided)
- Submitting claims when applicable provider requirements have not been met (therapist lacks proper credentials or is on an exclusion list)
- Certifying attendance for a complete related service session when a complete session was not provided
- Intentionally falsifying or altering documents pertaining to the delivery of related services
- Submitting fraudulent Medicaid cost reports in connection with related services
How to Report
- Contact the DOE Medicaid Compliance Officer, Dina Karagiorgos: Office: 212-374-0274, email: Medicaid@schools.nyc.gov
- Contact the DOE Confidential Medicaid in Education Fraud and Abuse Hotline: toll free 877-393-5432
- Contact the Special Commissioner of Investigation for the NYC School District: toll free 877-888-8355
- Contact the NY State Office of the Medicaid Inspector General: toll free 877-873-7283
By email: Medicaid@schools.nyc.gov
NYC Department of Education Medicaid Compliance Officer
PERSONAL AND CONFIDENTIAL
52 Chambers Street, Room 319
New York, NY 10007
We Offer You Protections
- are kept confidential to the extent possible
- may be reported anonymously—but you should include as much information as possible without investigating on your own
Federal, NY State, and NY City Whistleblower Laws protect from retaliation those who report compliance concerns in good faith
Compliance Officer Contact Information
Dina Karagiorgos, JD, CHC
NYCDOE Medicaid Compliance Officer
52 Chambers Street, Room 319
New York, NY 10007
Medicaid Compliance Plan
The DOE plans to ensure compliance with federal and state regulations for billing Medicaid through the School Supportive Health Services Program.