Privatized service delivery within Medicaid has greatly increased over the past two decades. This public program--private sector collaboration is quite common today, with a majority of Medicaid recipients receiving services in this fashion; yet controversy remains. This article focuses on just one program within Medicaid, school-based services for children with special education disabilities--the Medicaid School Program. A survey of public school districts within a region of one Midwest state found some expected results: Most districts were enrolled in the Medicaid program and receiving reimbursements for services; annual revenues were moderate; and a majority of districts provided most of the available Medicaid services. However, it was also found that almost every school district contracted with an outside private company to perform most of the Medicaid administrative functions (eligibility, billing, compliance), and almost every district was extremely satisfied with this collaborative arrangement--benefiting both entities. Support for this type of partnership is discussed in the context of public schools' and the social work profession's current fiscal and political challenges.