School Health and Related Services

The School Health and Related Services (SHARS) program allows Texas local educational agencies (LEAs) and shared service arrangements (SSAs) to request reimbursement for Medicaid health-related services. The Admission, Review, and Dismissal (ARD) committee determines SHARS services. Services must be medically necessary and reasonable to ensure that children with disabilities are able to participate in the educational program.

SHARS reimbursement is available for children who meet all of the following requirements:

  • 20 years of age and younger;
  • current eligible for Medicaid;
  • enrollment in a public school's special education program;
  • meet requirements for special education described in the Individuals with Disabilities Education Act (IDEA);
  • current Individualized Education Program (IEP) that prescribe the needed services.

Services covered by SHARS include:

  • Audiology services
  • Counseling
  • Nursing services
  • Occupational therapy
  • Personal care services
  • Physical therapy
  • Physician services
  • Psychological services, including assessments
  • Speech therapy
  • Specialized transportation as defined by the Texas Health and Human Services Commission (THHSC)

COVID-19: General Guidance

The Health and Human Service Department (HHSC) provides guidance for the implementation of SHARS services during current school closures.

2019 SHARS Cost Report Submission

Certification of Funds Letters to be Emailed

SHARS Services Provided through Telehealth

Medicaid flexibilities (expanded telehealth) have been extended through October 23, 2020. These extensions remain in effect unless the U.S. Secretary of Health and Human Services ends the public health emergency earlier. If the public health emergency ends earlier or is extended, HHSC will provide additional information.



Districts that provide SHARS services (including new providers) may consider applying for the HHS COVID-19 Provider Relieve Fund.

    • These funds can assist with district’s COVID-19 related expenses. 
    • Applicants who submit by Friday, November 6, 2020 at 11:59 p.m. ET will be considered for funding.
    • Some districts received payments during the Phase 2- General Distribution. Districts may be eligible for Phase 3 if they did not receive 2% of their annual patient care revenue.
    • More info is available at: COVID-19 Provider Relief Fund
    • Here is the link to the application.


    Enrollment in SHARS  

    A district must enroll as an active Medicaid provider for SHARS to become eligible to submit claims and receive reimbursement for SHARS Medicaid services.  Additional information about becoming a SHARS Medicaid provider is located on the Texas Health and Human Services Commission website.


    Parental Notice and Consent   

    LEAs and SSAs are required to provide notification and obtain targeted parental consent before accessing a child’s or parent’s public benefits or insurance.

    Written Notification 

    LEAs and SSAs must provide written parental notification prior to requesting consent and accessing benefits for the first time and annually thereafter.  Minimally, it must include: 

    1. A statement of the parental consent to access public benefits {34 CFR 300.154(d)(2)(iv)(A)-(B)]:

    •  specify the personally identifiable information that may be disclosed (e.g., records or information about the services),
    •  describe the purpose of the disclosure (e.g., billing for specific IEP services),
    •  identify the agency to which the disclosure may be made (e.g., Medicaid).

    2. A statement of the "no cost" provisions: voluntary participation will not decrease lifetime benefit or incur out-of-pocket expense [34 CFR 300.154(d)(2)(I)-(iii)];

    3. A statement that the parents have the right to withdraw their consent at any time (34 CFR part 99 and part 300); and

    4. A statement that the withdrawal of consent or refusal to provide consent does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents [34 CFR 300.154(d)(2)(v)].

        The notification must be written in language understandable to the general public and in the native language of the parent or other mode of communication used by the parent, unless it is clearly not feasible to do so [34 CFR 300.503(c)].

           One-Time Written Consent

          LEAs and SAAs  must obtain parental consent before releasing a child's personally identifiable information for billing purposes to a public benefits or insurance program for the first time.  Minimally, it must include:

          1. A statement of the parental consent to access public benefits [34 CFR 300.154(d)(2)(iv)(A)-(B)]:

          • specify the personally identifiable information that may be disclosed (e.g., records or information about the services),
          • describe the purpose of the disclosure (e.g., billing for specific IEP services),
          • identify the agency to which the disclosure may be made (e.g., Medicaid).

            2. A statement indicating that the parent understands and agrees that the public agency may access the child’s or parent’s public benefits or insurance to pay for specific services identified in the child's IEP.

              Guidance Regarding Parental Consent for the Use of Public Benefits or Insurance


              Texas Medicaid Policy- Third Party Liability (TPL) for SHARS Interim Billing

              Enrollment in SHARS is optional for districts and parents.  Participation does not preclude the district's responsibility to provide a free and appropriate public education to all students with disabilities.   Parents/adult students cannot be charged for special education services provided to students with disabilities. 

              Beginning on October 1, 2017, a new policy was instituted.  After Medicaid reimburses districts for SHARS services, the state may seek recovery claims from a student's private insurance.  The THHSC has decided to begin a lookback period on SHARS TPL claims on October 1, 2020.

              School districts have the responsibility to share the TPL policy with all families participating in the SHARS program:

              • Share the policy with parents/adult students. Ensure that they understand their right to withdraw consent to participate in SHARS.

              • If parents produce a document they believe is an insurance bill:

                • verify whether the document is a bill;  Some documents may include an Explanation of Benefits (EOB) that may or may not indicate that money is owed; and

                • if it is an insurance bill, contact the TMHP Contact Center at 1-800-925-9126.

              Information regarding TPL can be found on the Texas Medicaid Healthcare Partnership (TMHP) website: Third Party Liability for SHARS Interim Claims.



              Implementation Guidance

              The oversight of SHARS is a cooperative effort between the TEA and the HHSC.  TEA monitor activities are intended to ensure adherence to Medicaid standards as well as ensure the implementation of quality student services.

              TEA support includes:

              • monitor compliance with documentation guidelines,
              • perform regular desk reviews and field audits;
              • provide policy clarifications to districts,
              • validate data submitted for SHARS billing;
              • work to minimize exposure to provider waste, program abuse, and fraud.

              District Self-Monitoring Tool



              Additional Resources and Training

              Frequently Asked Questions (FAQ)

              Personal Care Services- What it is and what it is NOT

               HHSC Rate Analysis/ Payment Information

               SHARS Update: Bulletin Registration

              Office of Inspector General (US Department of HHS): Centers for Medicare and Medicaid (CMS)