Special Education Medicaid Initiative SEMI

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 a student’s Individualized Educational 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 regulations regarding Medicaid parental consent for school-based services changed. Now the regulations require that, prior to accessing a child’s public benefits or insurance for the first time, and annually thereafter, school districts must provide parents/guardians with written notification and obtain a one-time parental consent. 

No, IEP services are provided to students while at school at no cost to the parent/guardian. 

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. 

• Evaluations
• Psychological Counseling
• Speech Therapy
• Audiology
• Occupational Therapy
• Nursing
• Physical Therapy
• Specialized Transportation

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 the type of services delivered.

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. 

You have the right to withdraw consent to allow Medicaid billing at any time by contacting the school in which your child is enrolled.

No. Your school district is still required to provide services to our child pursuant to his or her IEP regardless of your Medicaid eligibility status or your willingness to consent for SEMI billing. 

Please call the Office of Special Services at 201-816-4534 with questions or concerns, or to obtain a copy of the parental consent form.