The Intersection of Medicaid, Special Education Service Delivery, and the COVID-19 Pandemic

Appendix A

What does federal special education law require?

Under the federal Individuals with Disabilities Education Act (IDEA), school districts must provide children with disabilities with the services necessary to receive a “free appropriate public education.” ¹ The IDEA applies to children from birth through age 21² and also provides federal funds to assist states with meeting these obligations. Under the IDEA’s “child find” requirement, states must identify and evaluate all children with disabilities, including those who are homeless and those who attend private schools.³ A parent also may request an evaluation for their child. A team of “qualified professionals” and the child’s parent then reviews the evaluation findings to determine whether the child meets the IDEA’s definition of a “child with a disability.”⁴ Children qualify if they are in need of special education and related services due to an intellectual disability, hearing impairment, speech language impairment, visual impairment, emotional disturbance, orthopedic impairment, autism, traumatic brain injury, another health impairment, specific learning disability, deaf-blindness, or multiple disabilities.⁵

In addition to special education services, children with disabilities may be entitled to “related services” such as therapies or other supportive services. “Related services” include transportation as well as “developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education.”⁶ Types of related services include speech-language pathology and audiology, interpreting, psychological, physical and occupational therapy, recreation, counseling, orientation and mobility, school health and school nurse, social work in schools, and parent counseling and training. Related services do not include medical services, unless used for diagnostic or evaluation purposes.

Children who qualify for special education must be served in the “least restrictive environment.” This means that children with disabilities must be educated with their nondisabled peers “to the maximum extent appropriate.” Children with disabilities may be placed in separate classes or separate schools or otherwise removed from the regular education environment “only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.”⁷

A team determines the services that a child receives and the child’s educational placement. The team includes the child’s parent, a regular education teacher, a special education teacher, a school district representative, and someone who can interpret the instructional implications of evaluations. The team also may include other individuals with knowledge or special expertise, such as related services personnel, and should include the child “whenever appropriate.”⁸ Notably, a child with a disability under the IDEA does not have to receive all of the special education and related services that would enable them to achieve their maximum potential. Instead, according to the U.S. Supreme Court, school districts only must provide services that are “reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.”⁹

Children who do not qualify for special education services under the IDEA may be eligible for reasonable accommodations under Section 504 of the Rehabilitation Act. This federal law prohibits disability-based discrimination in programs or activities that receive federal financial assistance, including public schools. Students qualify under Section 504 if they have a physical or mental impairment that substantially limits one or more major life activities. Examples of major life activities include caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.¹⁰ Children with disabilities who are eligible under Section 504 may receive “regular or special education and related aids and services designed to meet the[ir] individual educational needs. . . as adequately as the needs of students without disabilities are met.”¹¹ Examples of reasonable accommodations that may be in a Section 504 plan, depending on a child’s needs, include extra time to take tests or materials in alternative formats.

Appendix B