• Annual Written Notification and Medicaid Consent

    Î÷Ê©Ö±²¥APP School District (ASD) students and families must provide a one-time consent to ASD for ASD to access Medicaid reimbursement for eligible services provided to students. Additionally, ASD must provide an Annual Written Notification to students and their families, informing them of their Medicaid rights as they apply to ASD's School-Based Medicaid program. Beginning with the 2023/2024 school year, ASD provides these documents with student enrollment and registration forms for all ASD students. These documents are available below for viewing and download in English, Hmong, Korean, Samoan, Spanish, and Tagalog. Contact the ASD School-Based Medicaid office to request translations into another language, or to have a hardcopy document mailed to your home.

  • ASD SBS Medicaid Forms
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