Denair Unified School District - Medi-Cal

Medi-Cal - F.A.Q.

What is school-based Medicaid?title

In 1989, Congress enabled school districts to claim federal funds for certain health related services they provide to students who have IEPs and who are enrolled in Medicaid. Districts can seek reimbursement from Medicaid for these services as long as the district is a Medicaid provider and meets requirements regarding licensure, certification, and other federal mandates for the Medicaid program.

Note: Medicaid is called Medi-Cal in California.

What is the difference between LEA and MAA/RMTS?

What is the difference between LEA and MAA/RMTS?title

California established the Local Education Agency (LEA) Medi-Cal Billing Option Program in 1993 and the Medi-Cal Administrative Activities Program (MAA) in 1994.

The Local Education Agency Medi-Cal Billing Option program is a fee-for- service program, which includes direct assessment and services to Medi-Cal eligible children. Claims which capture this direct service require the name of the student, the name of the provider, the date of service, and supporting documentation for the nature and extent of the services.

Reimbursements for LEA direct services are returned to the District as General Fund- Restricted funds. Funds are restricted by the oversight of a Collaborative Board as defined in the California state education code.

For more information about the LEA Medi-cal billing Option programs see the DHCS website: http://www.dhcs.ca.gov/provgovpart/Pages/LEA.aspx

The Medi-Cal Administrative Activities (MAA) Program claims reimbursement for administrative activities, including outreach and enrollment, referral to Medi-Cal services, and other specific administrative activities that improve and support Medi-Cal services to children. The District is required to implement a quarterly time study methodology completed by District personnel in order to claim this revenue. DUSD uses a time sampling methodology known as Random Moment Time Survey (RMTS).

Reimbursements for the MAA/RMTS program are returned to the District as General Funds.

For more information about the MAA/RMTS program see DHCS website:

http://www.dhcs.ca.gov/provgovpart/Pages/SMAA.aspx

What is the LEA Collaborative?

What is the LEA Collaborative?title

California requires that each district participating in the LEA Medi-Cal Billing Option program form a community collaborative group to make decisions on the reinvestment of funds returned to school districts. The Collaborative funds supplemental health and human services for the purpose of supporting academic success.

How are LEA funds allocated?

How are LEA funds allocated?title

Each year the LEA Collaborative allocates funds generated by the LEA Medi-Cal Billing Option program to a variety of groups including, Healthy Start, provider groups (audiology, counseling, occupational and physical therapy, nursing, school psychologists, speech therapy), the Division of Special Education and the Division of Student Health and Human Services. Allocation recipients are required to report reinvestment outcomes to the Collaborative during the year the allocation was awarded and prior to the Collaborative decision to allocate funds in successive years.

Why does the total dollar amount available for allocation vary from year to year?

Why does the total dollar amount available for allocation vary from year to year?title

Many variables affect the actual dollar amount the District receives each year. These include the percentage of children in Medi-Cal at any given time and the number of Medi-Cal eligible services that are documented by District services providers, which meet the requirements for billing. Revenues can also vary according to regulatory changes made by the state and federal governments.

Do LEA funds carry-over from year to year?

Do LEA funds carry-over from year to year?title

The decision to carry-over LEA funds is made on a yearly basis by Budget Services.

Once an allocation has been made, how is the use of the LEA funds determined?

Once an allocation has been made, how is the use of the LEA funds determined?title

The LEA Collaborative determines the dollar allocation. District administrators budget the funds keeping within the general state requirements to supplement not supplant district services. The California Provider Participation Agreement does require signatures on an annual basis of field staff, budget personnel and program administrators who have participated in the budget process for their programs.

What can LEA reimbursement be used for and how are these decisions made?

What can LEA reimbursement be used for and how are these decisions made?title

State regulation establishes broad outlines for the types of supplemental services, which can be funded. In addition, the CA Department of Health Services, as well as the Collaborative, further define how the money is allocated. For example, the California Department of Health Services has informed districts that professional conference attendance does not qualify as a supplemental service.

What constitutes supplanting or supplementing (and what is allowed)?

What constitutes supplanting or supplementing (and what is allowed)?title

LEA funds may be used to supplement, but not supplant, District services. Supplementary services are those services over and above those, which are funded routinely by the General Fund. Supplanting is the funding of services for special or general education for which the District is responsible.

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