Unless using some other form of funding, you would need to be in contact with the State Medicaid Office to gain approval for reimburesement.  Our experience has been that having close contact to work through the issues of training/certification, delivery model, etc., is really important.   

I would second Abby's assessment. When I was in New York State, the relationship and collaboration with our State Medicaid Office was a really critical factor.  This was underscored by responses in our survey identifying State Medicaid Agencies as the most influential groups.

There are some other types of healthcare financing mechanisms at the local level that may not need involvement from the State Medicaid Agency, including hospital community benefit programs (for more information:  http://www.nchh.org/Resources/HealthcareFinancing/HospitalCommunityBene…).

Finally, there are some payment models where a local organization may be involved in developing a service to take advantage of available Medicaid funding but not have to have a direct relationship with their Medicaid agency.  An example of this is the DSRIP funding pool currently available in New York State where a local organization may work with a safety net provider to apply for funds to develop a service at the local level.  https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/