School Eligibility vs Medical Eligibility
Understanding the Difference and How They Work Together
When I was working in the schools, I would often encounter parents who had questions about why they needed school testing for special education services when they already had an outside or medical diagnosis or eligibility. The staff and I would then explain the differences between the two systems, as both are important but serve different purposes
It’s not uncommon for students to begin their journey toward support with an outside evaluation- perhaps from a speech therapist, occupational therapist, psychologist, or neurologist. These medical professionals diagnose using clinical criteria, such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), focusing on how a condition presents in daily life and its impact beyond school.
However, schools must determine educational eligibility, which is different from the eligibility criteria for other programs. Even if a child has a medical diagnosis, the school must assess whether that condition adversely affects the student’s educational performance and requires specialized instruction to access the curriculum. This process ensures that services provided under the Individuals with Disabilities Education Act (IDEA) or Section 504 are tailored to the child’s educational needs rather than their medical treatment needs.
How It Looks in Practice
A child may have a medical diagnosis of ADHD from a pediatrician. This diagnosis helps famiies understand their child’s challenges and my guide treatment, such as medication or therapy. But when the school evaluates the same child, the focus is on how ADHD impacts their ability to learn, focus, or complete schoolwork in the educational environment.
If the evaluation shows that the student’s attention difficulties significantly interfere with academic progress and require specially designed instruction, they may qualify for special education under the category of Other Health Impairment (OHI). If the student’s needs can be met through accommodations without specialized instruction, they may instead qualify for a Section 504 plan.
Similarly, a child with autism, speech impairments, or occupational therapy may receive an outside diagnosis based on medical criteria. Still, school eligibility under the IDEA category of Autism, Speech Impairment, and related services for Occupational therapy depends on whether the characteristics affect their educational performances. This distinction doesn’t mean the school is questioning or dismissing the medical diagnosis- it simply means that schools use a different lens to determine the type and level of support a student needs within the educational setting.
Why Schools Complete Their Own Evaluations
Understandably, this can feel confusing or even frustrating for families. Many parents hear “the school has to do its own testing” and think that means the school doesn’t believe the outside results. In reality, the school’s evaluation ensures that the team has a complete picture of the student’s strengths, needs, and how those impact their ability to learn and make progress in the classroom.
Schools must gather their own data to meet legal requirements and to design the most effective educational supports. Outside evaluations are valuable and can be shared as part of the data reviewed by the school team, but they don’t automatically determine educational eligibility.
Working Together for Student Success
Understanding the difference between medical and school eligibility helps parents approach the process with confidence rather than frustration. Both systems provide valuable information from different perspectives, and when combined, they create a stronger foundation for supporting the child’s growth. Parents can play a powerful role by sharing medical information, observations, and insights with the school team-and by listening to how their child functions in the classroom setting.
When everyone works together, the focus stays where it belongs- helping the student thrive both academically and personally.