Federal Guidance and Analysis

Center for Medicare and Medicaid Services, HHS. Medicaid School-Based Administrative Claiming Guide, May 2003. The purpose of this guide is to inform schools, state Medicaid agencies and other interested parties on the appropriate methods for claiming federal reimbursements for the costs of Medicaid administrative activities performed in the school setting.

Medicaid.gov. Medicaid: Early and Periodic Screening, Diagnostic, and Treatment (EPSTD).

Government Accountability Office (GAO). June 2005. Medicaid: States Efforts to Maximize Federal Reimbursements Highlight Need for Improved Oversight.
GAO-05-836T, June 28, 2005.

GAO. Medicaid and Special Education: Coordination of Services is Evolving (Letter Report, 12/10/1999, GAO/HEHS-00-20). Pursuant to a congressional request, GAO reviewed the mechanisms of coordination between Medicaid and the Individuals With Disabilities Education Act (IDEA), focusing on: (1) how Medicaid and IDEA interact to meet the needs of low-income school-aged children with disabilities; and (2) issues that have arisen in coordinating Medicaid and IDEA services in schools

GAO Testimony before the U.S. Senate Finance Committee (06/17/99, GAO/T-HEHS-99-148). Pursuant to a congressional request, GAO discussed the rise in claims for administrative costs associated with school-based health services, focusing on: (1) trends in Medicaid’s spending for administrative costs; (2) the distribution of Medicaid payments for administrative claims to schools and other entities; and (3) the adequacy of federal oversight in approving school districts’ claims for reimbursement. www.gao.gov/archive/1999/he99148t.pdf

GAO. Medicaid in Schools: Improper Payments Demand Improvements in HCFA Oversight (Letter Report, 04/05/2000, GAO/HEHS/OSI-00-69). Pursuant to a congressional request, GAO provided information on states’ practices regarding Medicaid reimbursement of school-based administrative activities, focusing on: (1) the extent to which school districts and states claim Medicaid reimbursement for school-based health services and administrative activities; (2) the appropriateness of methods states use to establish bundled rates for school-based health services and assess the costs of administrative activities that their schools may claim as reimbursable; (3) states’ retention of federal Medicaid reimbursement for services provided by schools and schools’ practice of paying contingency fees to private firms; and (4) the adequacy of the Health Care Financing Administration’s (HCFA) oversight of state practices regarding school-based claims, including safeguards employed to ensure appropriate billing for health services and administrative activities.  www.gao.gov/new.items/h600069.pdf

State Guidance and Analysis

Sawyer J. Medicaid Claiming.The School Administrator. American Association of School Administrators. March 2003. http://www.aasa.org/publications/saarticledetail.cfm?ItemNumber=2555&snItemNumber=&tnItemNumber


Colorado School Health Services Program Description. The School Health Services Program is a state program started in Colorado in 1997. That year, the state legislators pass a law to help pay for health services for children in public schools. Any public school district of Board of Cooperative Services (BOCES) can participate in this program. Basic requirements of the program are described http://www.chcpf.state.co.us/HCPF/school/intro.asp


State of Delaware. Department of Human Services. School-Based Health Services Provider Specific Policy Manual.


Agency of Health Care Administration. Florida Medicaid Certified School Program Match Coverage and Limitations Handbook. A guide to the state-wide Medicaid Administrative Claiming System (MACS) program. December 2005. http://ssn.usf.edu/medicaid/documents/MedicaidCertifiedSchool

Review of Administrative Costs Claimed by the Florida Medicaid Agency for School-Based Health Services (Report, 03/22/01, A-04-00-02160). The State agency developed a guide which offers some control over the claiming of administrative costs. However, the administrative costs claimed by the State agency, as reported by the local school districts, still included unallowable costs, unsupported costs, and costs based on improper documentation. We found problems at the four school districts we visited, and believe similar problems could exist at the other school districts because of a lack of program oversight. We did not determine the financial effect of our findings, however, we believe our findings indicate that better controls are needed to provide assurance that costs claimed for Federal reimbursement are proper. We are recommending that the State agency establish controls to more closely monitor the administrative costs claimed by school districts, including performing more onsite reviews at the school districts. The State agency generally agreed with our findings and recommendations. www.oig.hhs.gov/oas/reports/region4/40002160.htm


Medicaid Services – Kentucky Department of Education. The 2003 General Assembly, through the enactment of House Bill 269, authorized the Department of Education to implement a strategy for maximizing federal reimbursement under the Medicaid Program for Medicaid eligible administrative functions performed by elementary and secondary schools. This document describes the steps local school districts must take to participate in the Kentucky School Based Health Services Program http://www.education.ky.gov/KDE/Administrative+Resources/


Texas Association of School Boards. School Health Services. How the Texas State Medicaid program reimburses school districts for health services provided to students with disabilities who are enrolled in Medicaid. Covered services include assessments, speech therapy, physical therapy, audiology, psychological services, counseling, medical services, school health services, special transportation, occupational therapy.

State of Texas. Best Practice Description: Maximizing Medicaid Reimbursements http://www.lbb.state.tx.us/tsprp/AIMSAreaofReview/

Texas Maximizing Federal Reimbursements for Medicaid School Health and Related Services (SHARS). An analysis of why school districts in Texas are not participating in billing for reimbursements through the SHARS program.