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School districts settle up on Medi-Cal Administrative Activities reimbursements  

The School-Based Medi-Cal Administrative Activities program promotes access to healthcare for students without insurance, helping to prevent high-cost or long-term health problems. The SMAA program provides reimbursements to local educational agencies for the federal share of certain costs associated with administering the Medi-Cal program in schools.

In 2012, the Center for Medicare and Medicaid Services (CMS) conducted an audit of three LEAs, and notified the California Department of Health Care Services (DHCS) that it would defer payments for SMAA claims due to noncompliance with federal regulations until the state revised its claiming methodology.

In October 2014, DHCS reached a settlement agreement with the CMS for the payment of deferred invoices from fiscal years 2009–10 through 2014–15, as well as a new methodology for resolving SMAA claims. As part of this agreement, many districts owe money for overpayments the districts received.

Districts should already be aware of the money they owe, as this process has been going on for several years. Some districts have settled their payment debt through the submittal of a check using funds from their previous years’ budget. Districts that have not done this will see their SMAA debt paid through a reduction in the one-time discretionary funds allotted to districts in the 2018–19 State Budget. The budget approved by Gov. Jerry Brown includes language that allows for the reduction in a school districts’ Proposition 98 one-time discretionary funding if the school district is required to repay CMS. DHCS and the Department of Finance are currently developing the process for how the money will be collected.  DHCS will be providing a list of school districts including the overpayment amounts to CMS in June 2018, December 2018 and May 2019.

As a reminder, the activities that the SMAA program reimburses school districts for include: Outreach and referral; Facilitating the Medi-Cal application; Arranging non-emergency/non-medical transportation; Program planning and policy development; and MAA claims coordination. Districts should work with their local educational consortium or local governmental agency to clarify any questions they have about reimbursement or what the district owes in repayment.

In order to provide clearer directions in another Medi-Cal based funding program,  CSBA is co-sponsoring Assembly Bill 3192 (O’Donnell, D-Long Beach) to develop an audit guide for the LEA Medi-Cal Billion Option which provides reimbursements to school districts for approved health-related services for Medi-Cal eligible students.   AB 3192 would require the DHCS to prepare and complete a fiscal and program compliance audit guide for the LEA Billing Option.  This guide will provide clarity and appropriate direction to both auditors and school districts.  DHCS will be required to distribute the audit guide to LEAs by June 30, 2019.