One in Six School Districts Has Dropped Medi-Cal Referral Program
Nearly one in six California school districts has abandoned a program that reimburses schools for some of the cost of referring students to Medi-Cal, the state's Medicaid program, according to a state audit, EdSource reports (Adams, EdSource, 9/21).
For the audit, investigators reviewed the California Department of Health Care Services' oversight of the:
- School-Based Medi-Cal Administrative Activities program; and
- Local Educational Agency Medi-Cal Billing Option Program (California State Auditor report, August 2015).
According to EdSource, 966 school districts in California in fiscal year 2011 collected $200 million through the program to cover administrative time spent:
- Arranging for Medi-Cal covered services, such as speech therapy, counseling and dentistry;
- Discussing student health needs; and
- Translating information for families.
However, a federal investigation released in 2013 found "serious deficiencies" in California's oversight and management of the administrative activities program.
Following the investigation, federal officials:
- Temporarily froze payments to school districts in the state;
- Recalculated previously paid claims submitted between 2011 and 2012; and
- Implemented a formula for interim payments and devised a new method of calculating claims.
According to EdSource, some school districts still are waiting to be reimbursed for 2009 expenses, and others have been ordered to return money from previous reimbursements that now are under review.
According to the state audit, 145 California school districts as of March had dropped out of the Medi-Cal referral program. More than 800 districts in the state still are participating (EdSource, 9/21).
The audit also found that while DHCS' review process for claims was "reasonable," it failed to result in approval of many deferred claims. Specifically, less than 10% of claims submitted under the DHCS process were approved.
The audit also found that DHCS has failed to:
- Adopt regulations for the administrative activities program as required by state law;
- Maximize participation of claiming units in the administrative activities program, meaning the state could be missing out on an estimated $10.2 million in increased federal funding annually;
- Increase the reimbursement rate for translation activities to the rate permitted under federal law, resulting in the failure to claim about $4.6 million in federal funding; and
- Issue to the state Legislature a required annual report for the billing option program.
The audit recommended that the state Legislature should:
- Modify state law to allow claiming units to submit reimbursement claims directly to DHCS; and
- Require DHCS to issue annual reports for the administrative activities program.
Meanwhile, the audit recommended that, among other things, DHCS should:
- Develop regulations for a formal appeals process that allows claiming units to appeal the department's decisions;
- Improve its oversight of local educational consortia and local governmental agencies to ensure that they meet the terms of their contracts; and
- Minimize the risk of claiming units including unallowable costs when calculating reimbursement claims (California State Auditor report, August 2015).
According to EdSource, DHCS agreed with several of the audit's recommendations (EdSource, 9/21).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.