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(4.57) May a school district require that I use my medical insurance to pay for part of my child’s special education program?

(4.57) May a school district require that I use my medical insurance to pay for part of my child’s special education program?

No. The district must get your written consent before it may use the private insurance to pay for any special education costs for your child. When a district asks for consent, it must tell you that your refusal to consent does not relieve the district of its responsibility to provide the special education and related services. If you would otherwise consent to the use of your insurance — whether private or public — except for the fact that you would have to pay a deductible or co-payment, the district may use its funds to pay the deductible or co-payment.

Federal and state law does allow school districts to use public and private insurance to help pay for the costs of special education or related services in certain circumstances. [34 C.F.R. Secs. 300.154(d-f); Cal. Ed. Code Sec. 56363.5.]

Children eligible for public insurance, such as Medi-Cal, cannot be required to enroll in this insurance plan just so that a district can use Medi-Cal to pay for services. Those already enrolled in Medi-Cal cannot incur any out-of-pocket expenses, such as payment of deductibles or co-payments, for services which are part of a student’s appropriate education. But, a school may pay those deductibles or co-payments and avoid this problem. Public insurance cannot be used if it would:

  1. Decrease available lifetime coverage or any other insured benefit;
  2. Result in the family paying for services otherwise covered by Medi-Cal and which are required by the child outside of school;
  3. Increase family premiums or lead to termination of coverage; or
  4. Risk the loss of eligibility for home and community waivers, based on aggregate health-related expenditures.[34 C.F.R. Sec. 300.154(d)(2)(i -(iii).]