Exceptional Children » Medicaid - Annual Written Notification

Medicaid - Annual Written Notification

Annual Written Notification

Accessing Public Benefits and Releasing Personally Identifiable Information

 to the North Carolina Division of Health Benefits (NC Medicaid)

Davidson County Schools

P.O. Box 2057 Lexington, NC 27293


Federal law requires each State to develop agreements with non-educational public agencies to ensure all services necessary to provide a free appropriate public education (FAPE) are provided to children with disabilities at no cost to the parent. This includes the State Medicaid agency when local education agencies (LEAs) are seeking reimbursement for some health care services provided at school. 


Under the Family Education Rights and Privacy Act (FERPA), parent consent is required for the school system to release information about your child to the North Carolina Division of Health Benefits (NC Medicaid) in order to access your or your child’s public benefits. You are entitled to have a copy of any information the school system releases to the state Medicaid program. 


The funds collected from Medicaid in this school system will be used to:

Help support the Exceptional Children’s program by securing resources, including supplies and materials necessary to assist children fully access their educational needs.


         This notice is to parents who have given prior written consent for Davidson County Schools to release information needed to access North Carolina Medicaid reimbursement for services provided through their child’s Individualized Education Program (IEP); Individualized Family Service Plan (IFSP); Section 504 Plan; Individualized Health Plan (IHP); or Behavior Intervention Plan (BIP).


         This annual notice confirms the school district may release: 

  • Your child’s name;
  • Medicaid number;
  • Your child’s date of birth;
  • Your child’s service documentation, including evaluations;
  • The dates and times services are provided to your child at school;
  • Reports of your child’s progress, including therapist notes, progress notes and report cards.


Your child will continue to receive all required services at no cost to you. You may revoke your consent at any time. Revoking your parental consent does not change the school district’s responsibility to provide all required plan services at no cost. You may ask questions about this program or revoke your consent at any time by contacting Stacey Wilson at (336)242.5516 or [email protected].




Revised 6.15.2021

Spanish - Annual Written Notification