Districts Facing Hurdles in Collecting Medicaid Refunds (US)

March 30, 2011

Districts are continuing to face many challenges in filing for reimbursement for the Medicaid services they provide to students, according to the 2009 Biennial Survey: Trends and Data released Jan. 25 by the National Alliance for Medicaid in Education (NAME), a nonprofit organization representing state Medicaid and education agencies. The report examines Medicaid reimbursements, primarily over the last decade. It shows the amount of districts that have students qualified for Medicaid that are claiming IEP mandated services, such as occupational therapy, physical therapy, speech therapy, mental health and nursing, have decreased in 2009. Training the staff to document their work and getting the credentials of the health care providers in the education settings to match up with the Medicaid program are still problems for districts, some of which are seeking millions of dollars in reimbursements.

“These in-school care providers are people who are really passionate about kids and education, but all this takes away from working with kids,” says Cathy Griffin, chair of NAME’s Education and Research Committee.

Direct billing and the Medicaid administrative claiming program are two school-based programs that districts can participate in to bridge the funding gap for programs mandated by the Individuals with Disabilities Education Act (IDEA) that are not fully paid for. Direct billing allows districts to claim reimbursements for the cost of providing health-related services, and administrative claiming partially compensates districts for the costs associated with documenting services. Students must be in special education and Medicaid-eligible to qualify for funds. “It’s very laborious to tr ain school staff and fill out quarterly paperwork, but we still used those funds,” says Terry Stewart, retired superintendent of Jennings (Mo.) School District and a member of the National Board of Advisors for Accelify, a Medicaid billing agent that provides districts with services and products to tap into Medicaid revenue. “If you’re a school district with a high concentration of poverty, you will really benefit from the program.”