The Ohio Department of Job and Family Services hasn’t fully reimbursed school districts for Medicaid related services since 2005. That’s when the state’s previous reimbursement system crumbled under a lack of oversight and a federally mandated expansion that would have stretched state resources too thin, state officials say.
That failure cost schools about $67 million in annual federal assistance.
When the state rolled out a new Medicaid School Program (MSP) in the 2009-10 school year, there was hope that financial assistance was again on the way for services as speech therapy, psychological testing and counseling.
Instead, they’ve received about half of what they are owed each of the last three years. They’re waiting for the rest.
“It shouldn’t take three years. It shouldn’t take two years. Heck, I don’t think it should take one year,” said Bryan C. Williams, an Akron-area member of the Ohio State Board of Education.
Williams, along with billing agents hired by schools and state officials, will meet twice in the next two weeks: once on March 6 to discuss $50 million owed to school districts for the first two years of the program.
“I ultimately want to get my clients that money,” said Dan Thomas, owner and operator of Lancaster-based Healthcare Billing Service Inc. Thomas hopes to resolve the state’s argument that schools exaggerated some claims and instead owe the state $14.6 million, which was overpaid because of a state error.
But it’s the next meeting, on March 12, prompted by Williams, that has Thomas and other billing-service companies most interested.
Williams will suggest an expansion of the Medicaid School Program to include reimbursements for school nurses, classroom aides and special education transportation. The expansion could add tens of millions of new federal dollars, according to Williams and Chris Meroff, executive director of Texas-based MSB Connections.
Meroff’s company, like Thomas’ Healthcare Billing Services, manages Medicaid bills for schools and would profit from an expansion.
More aid available
Meroff said that based on his work in Texas, he believes Ohio schools could receive another $200 million in federal aid if the state were to properly execute its Medicaid School Program.
“There are too many other states that are getting these funds,” Williams said.
Meroff said that recovering the $50 million from the past is “a one-time fix. That doesn’t solve the fact that we’re missing out on $200 million every year.”
He said that nurses, aides and transportation costs account for 70 percent of Medicaid claims for schools in other states, but Ohio is not pursuing those costs on behalf of its schools.
Among his clients in Summit County, he estimates Copley-Fairlawn would receive an additional $154,000, Woodridge $192,000 and Norton $252,000 — or about four times what they’re receiving now.
However, Thomas, the billing agent from Lancaster, cautioned that expanding the program could cause it to collapse, as it did nine years ago.
“Those are the same issues that shut down the last program,” Thomas said.
As the Medicaid School Program currently operates, schools receive partial, interim payment for Medicaid services to kids, pay for the remainder out of local school funds, then at the end of the year submit a bill for full reimbursement.
State wants settlement
The March 6 meeting is expected to focus on reimbursement for the 2009-10 school year, in which school billing agents argue that districts are owed about $25 million and the state is arguing that some received erroneous payments and need to make reimbursement first.
Once an agreement is reached for that year, the state is proposing to apply that reimbursement rate to four previous years, thus catching up with costs incurred by districts since 2005.
They will have to settle the disputed overpayments of $14.6 million claimed by the state.
“The overpayment is [the state’s] fault,” Thomas said. Thomas estimates that his 350 clients, including Akron Public Schools, provided more than $21.6 million in Medicaid reimbursable care for students in the 2009-10 federal fiscal year. The state paid about half that cost in monthly reimbursements. Districts have been waiting for the other half, or nearly $10.8 million, for eight months.
He estimates that, statewide, about $50 million is owed to 500 school districts enrolled in MSP.
“It is critical that cost reports are carefully analyzed and evaluated to ensure that all the information contained is correct,” said Sam Rossi, spokesman for the Office of Medical Assistance at the Ohio Department of Job and Family Services, which handles Medicaid claims.
He said that some services not billed in the interim payments were added later, and the state is asking that some of those additional billings be dropped before the meeting March 6.
Thomas expressed frustration.
“You go 6 months with nothing. Then they say they have concerns. Then an email voicing those concerns,” Thomas said. “It’s the pace that they’re doing it; that’s what’s frustrating with dealing with the state. It’s bureaucrats.”
“I think what we have is a bureaucracy that is to this point unaccountable because no one has been asking these questions publicly and they’ve been lethargic in pursuing these federal funds,” Williams said.
Doug Livingston can be reached at 330-996-3792 or firstname.lastname@example.org.