Public Notice: State Plan Amendment (SPA) 26-0001 For
School-Based Health Services (SBHS) Program Updates
03/31/2026
WEST VIRGINIA MEDICAID PROGRAM
SPA 26-0001 REGARDING
SBHS PROGRAM UPDATES AND EXPANSION OF ELIGIBLE POPULATION
Pursuant to 42 U.S.C. §1396a(a)(13)(1997) and 42 C.F.R. §447.205, the West Virginia Department of Human
Services (“Department”), Bureau for Medical Services (“BMS”) provides notice of the filing of a SPA, identified as
SPA 26-0001, for SBHS.
This SPA, if approved by the Centers for Medicare and Medicaid Services (CMS), will bring West Virginia into timely
compliance with federal guidance and requirements for school-based programs specified in the 2023 School Based
Services Technical Guide. Required changes update reimbursement and administrative claiming methodology and
processes. This SPA will also expand the SBHS-eligible population in West Virginia, at State option, as well as add
three new provider types able to participate in the SBHS program.
BMS, in partnership with the West Virginia Department of Education (WVDE) has been planning for implementation
of SBHS changes as required per federal requirements and guidance. While making required changes, the BMS is
also electing to expand the SBHS-eligible population in West Virginia to any Medicaid-eligible youth with an
Individualized Education Plan (IEP), Individualized Family Service Plan (IFSP), 504 Plan, other individualized health
or behavioral health plan, or where medical necessity has been otherwise established. BMS and WVDE are
additionally including three new provider types allowed to participate in and bill services under the SBHS program:
Board Certified Behavior Analysts (BCBAs), licensed Social Workers, and school counselors.
This SPA, if approved, will increase Medicaid SBHS program expenditures in Federal Fiscal Year (FFY) 2026 by
$1,765,248 and by $3,309,841 in FFY 2027. The SBHS program is paid entirely through federal dollars and therefore
is budget neutral to the State at the overall State budget level.
For purposes of this notice, BMS will make the SPA drafts available for public inspection between March 31, 2026,
and April 30, 2026. Written comments may be sent between the above referenced dates to the West Virginia
Department of Human Services, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-
3706, or by email at SPAComments@wv.gov.
Any written comments received will be available for review at the above address during normal business hours, 8:30
a.m. to 4:30 p.m.
