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Annual Written Notification and Medicaid Consent

Ê®·ÖÁùºÏ²Ê (Ê®·ÖÁùºÏ²Ê) students and families must provide a one-time consent to Ê®·ÖÁùºÏ²Ê for Ê®·ÖÁùºÏ²Ê to access Medicaid reimbursement for eligible services provided to students. Additionally, Ê®·ÖÁùºÏ²Ê must provide an Annual Written Notification to students and their families, informing them of their Medicaid rights as they apply to Ê®·ÖÁùºÏ²Ê's School-Based Medicaid program. Beginning with the 2023/2024 school year, Ê®·ÖÁùºÏ²Ê provides these documents with student enrollment and registration forms for all Ê®·ÖÁùºÏ²Ê students. These documents are available below for viewing and download in English, Hmong, Korean, Samoan, Spanish, and Tagalog. Contact the Ê®·ÖÁùºÏ²Ê School-Based Medicaid office to request translations into another language, or to have a hardcopy document mailed to your home.