SCHOOL-BASED MEDICAID

1. SCHOOL-BASEDMEDICAID Subtitle

2. New CMS Regulations Seven new regulations during the past 18 months, which threaten the health care safety net: • School-Based Administrative Claiming & Transportation*; • Targeted Case Management*; • Rehabilitation Services*; • Intergovernmental Transfers*; • Provider Taxes; • Graduate Medical; and, • Hospital Outpatient. (*Direct negative impact on public schools)

3. COALITION: Steering Committee • National Governors Association • American Academy of Pediatrics • American Hospital Association • American Association of Children's Hospitals • ARC/CP • National Association of State Directors of Special Education • American Association of School Administrators • National Assembly of School Based Health Centers • American Federation of Teachers • National Education Association • American Federation of State, County, and Municipal Employees • National Association of Public Hospitals • Council for Budget and Public Priorities • Chicago Public Schools • National Association of State Medicaid Directors/APHSA • First Focus • Children's Defense Fund

4. Congressional Moratoria June 26 2008 • The Senate passed an amendment to the 2008 supplemental war funding bill (HR 2642) which included provisions to extend the moratoria and/or delay the effective dates of 6 of the 7 regulations until April 1, 2009. • June 30, 2008 President Bush signed the bill into law.

5. http://www.theleanet.com/ LEAnet is hosting a Coalition “Fly-In” meeting on August 11, 2008, Washington, D.C.

6. http://www.medicaidforeducation.org/ Annual Conference Philadelphia, Pennsylvania September 24 – 26, 2008 “A Heritage of Services: Medicaid and Special Education” LEAnet It’s about the children… http://www.theleanet.com/ LEAnet It’s about the children… http://www.theleanet.com/

7. Update on Washington Activities Bruce Hunter, Executive Director American Association of School Administrators • Sustaining Our Heritage of Service Sara Rosenbaum, Hirsh Professor & Chair, Dept. of Health Policy George Washington University • Setting Integrity the Cornerstone James Sheehan, Medicaid Inspector General New York State Dept. of Health • Medicaid, Schools and Health Care Reform Judy Solomon, Senior Fellow Center on Budget and Policy Priorities

8. Indiana Medicaid IEP Fee for Service 1991: • The Indiana General Assembly passed Public Law 80-1994 (Indiana Code 12-15-1-16) requiring all school corporations to be enrolled in the Medicaid program. Fall 2002: • The Indiana State Budget Agency established a Medicaid/DOE Task Force. The purpose is to: • Identify and remove barriers to improve local schools ability to bill Medicaid for medically related IEP services; and, • Increase the number of school corporations billing Medicaid for medical related IEP services.

9. Indiana Government Structure

10. Indiana Medicaid IEP Fee for Service January 2003 • Indiana Dept. of Education/Division of Exceptional Learners organized and established a Medicaid Workgroup to provide assistance and practical insight to the assessment and development of educational tools. The Workgroup includes: • Office of Medicaid Policy & Planning • State Budget Agency • Directors of Special Education in School Corporations • Health Care Excel (Medicaid Surveillance and Utilization) • EDS (Medicaid Enrollment and Payment) • Contracted Billing Agents • INSOURCE (Parent Organization)

11. Indiana Medicaid IEP Fee for Service • August 2004 DOE’s Publication of “Medicaid Billing Guidebook” • June 2005 DOE’s Publication of “Medicaid Billing Tool Kit”

12. IndianaMACMedicaid Administrative Claiming January 2004 • The Family and Social Services Administration organized and established a workgroup to establish a Medicaid Administrative Claiming pilot program with Learning Well. The workgroup included: • Office of Medicaid Policy & Planning • State Budget Agency • Department of Education • Learning Well • Health Evolutions

13. IndianaMACMedicaid Administrative Claiming October 2007 • Centers for Medicare & Medicaid Services approved a Medicaid Administrative Claiming pilot project in Marion County (Indianapolis) • Projected Initial claim Quarter 1, 2008: $105,761 • Seeking federal approval for 2 years’ retroactive claiming (Jan ’06 - Dec ’07): • Quarter 1, 2006: $117,972 (projected) • Quarter 2, 2006: $ 89,753 (projected)

14. Unique Arrangement withLearning Well • Under approved pilot project, schools assign MAC match dollars to non-profit “school wellness collaborative” • Non-profit Learning Well invests MAC dollars in school-based clinics providing FREE care to students and their families

15. What is claimed? • 50% federal matching funds for publicschool staff time spent on Medicaid enrollment and application assistance, service coordination, and outreach Allowable costs: Direct costs (salary and benefits only) for percentage of public school staff time on claimable activities

16. IndianaMAC Pilot Project Status • Beta Site: MSD Perry Township Schools Initial training and sampling prior to federal approval in October, 2007 Retrained, initiated claiming January 2008 • Phased In Participation: Speedway Schools trained, initiated claiming April 2008 Next training September 2008, schools TBD

17. THE RIGHT PEOPLEA collaborative and collegial group across the state that is committed to improving access to healthcare for children. The Right People

18. THE RIGHT PURPOSEImproving access to healthcare for children. The Right Purpose

19. THE RIGHT APPROACHDeveloping a team approach to getting the work done…understanding that improvements cannot be made in a vacuum. The Right Approach