School Medicaid claims rejected again
(Calif.) After several years of negotiations, federal administrators of a school-based Medicaid program appeared this week to issue a final rejection of some $460 million in claims for services provided by California schools dating back to 2009.
Although state officials and advocates representing local educational agencies say they will continue to press the federal Centers for Medicare and Medicaid Services for higher reimbursements, a letter from the agency’s acting director to the California Department of Health Care Services suggests it has made its best and final offer.
That offer, which covers as many as 972 LEAs statewide, would pay 100 percent of claims submitted for less than $25,000; 75 percent for claims between $25,000 and $50,000; and 40 percent for claims above $50,000.
Hellan Roth Dowden, an advocate representing a coalition working with Local Education Agencies said the state has been given until April 1 to come up with a plan for reconciling the pending claims with the federal reimbursement offer.
“I’m sure there are going to be some meetings in the next week or so with the (state) department and the various stakeholders in the education community to develop some sort of strategy for dealing with this,” she said. “We don’t know what they want to do with this.”
Dowden noted that it is the largest districts – which serve the highest numbers of low-income students – who would be the biggest losers if the federal payment plan remains unaltered.
In some cases, LEAs would not only lose out on a big percentage of their federal claim but would end up owing the state moneyas well. Because federal money generally passes through the state before going to districts, a number of LEAs received their full reimbursement before claims payments began to be deferred.
Medicaid, known in California as Medi-Cal, is the nation’s primary program for providing health care to low-income families, the elderly and the disabled. It is a critical source of health care coverage for children and provides a range of care directed at K-12 students including medical screenings as well as dental, vision and hearing services.
Schools also serve as funnels for getting families and children into the system and typically incur significant expenses performing outreach, making eligibility determinations and other administrative duties.
Federal auditors raised questions about some claims submitted by California districts dating back to 2009, prompting Medicaid administrators to begin withholding reimbursements in 2012.
State officials have argued that not all districts have filed improperly.
Most districts attempted to keep the services going by using general fund money but last year some were unable to keep up and it resulted in layoffs for school nurses, speech pathologists, counselors School Medicaid claims rejected again :: SI&A Cabinet Report :: The Essential Resource for Superintendents and the Cabinet:
