Parental Consent - Medicaid

Due to recent changes in the Individuals with Disabilities Education Act (IDEA), districts are required to notify and obtain consent from families whose students qualify for Medicaid.

Parental Consent means: 

• To be fully informed about the School-Based Services program.
• To provide consent to release school records containing the student’s information to Michigan Medicaid and billing agencies for the purpose of participating in the School-Based Services program.
• To understand that consent is voluntary and can be revoked.

SBS Parental Consent Form

SBS Parental Consent Form (Arabic) (pdf)

SBS Parental Consent Form (Spanish)

The Medicaid School-Based Services form is a “separate consent form” to be signed by the parent/guardian at the IEP meeting.  It is up to each district to decide whether this form should be signed for all special education students.  This form, however, should be signed for ALL center-based students.  It is the responsibility of each special education office to maintain these consent forms to ensure that a signature is obtained at the time of the IEP meeting.  Feel free to print this form on the district’s letterhead.

School-Based Service Brochure     (B&W Copy)     (Color Copy)

School-Based Service Brochure (Spanish)   (Color Copy)

School-Based Service Brochure (Arabic) (Color Copy)

The School-Based Services brochure describes the program in detail while offering answers to “common parent/guardian questions”.  The brochure is to be distributed at the IEP meeting to all parents/guardians, not just the parents/guardians of Medicaid eligible students.  This PDF document is “open” on the first page for each district to type in the name and phone number of the district’s special education contact.  This allows the district to customize this brochure with their specific information.

SBS Parental Consent Letter

SBS Parental Consent Letter (Arabic) (pdf)

SBS Parental Consent Letter (Spanish)

If no signature is obtained from the parent/guardian at the IEP meeting, that does not relieve the district from this requirement.  Each district should establish a procedure for obtaining permission when the parent/guardian does not sign the consent form at the IEP meeting.  This letter may be used for that purpose.  If a parent/guardian refuses to sign, contact RESA’s Medicaid office immediately.

If the Parent/Guardian does not return a signed copy of either the SBS Parental Consent Form or the SBS Parental Consent Letter the district should make a "final parental consent request". To assist with this task, our office has developed a letter of last resort.  This letter is available by request.