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In 2012, the Center for Medicare and Medicaid Services conducted an audit of three LEAs, and notified the California Department of Health Care Services that it would defer payments for SMAA claims due to noncompliance with federal regulations until the state revised its claiming methodology.
In October 2014, the DHCS reached a settlement agreement with the CMS for 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.
- A settlement between the California Dept. of Health Care Services and the federal Center for Medicare and Medicaid Services has been reached
- If a district was overpaid by CMS and currently owes, the payment will be deducted from the districts’ Proposition 98 one-time discretionary funding
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 Billing 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.
Optimal student health contributes to successful student learning and achievement. “We know kids learn better when they are healthy — preventative health care services help kids stay well so that they can concentrate on what is going on in the classroom and get the most out of instruction,” said CSBA Senior Director of Policy and Programs Julie Maxwell-Jolly. “The Medi-Cal program helps students achieve through improved attendance and well-being. This means more time to learn and greater focus on lessons and activities — which results in improved student outcomes.”