With each passing year, the state owes Akron schools about $850,000 more in unpaid Medicaid expenses.
And each month, Akron spends on average $1 million on special education services that are covered in other states, but because Ohio does not fully participate in the federal reimbursement program, taxpayers here have to pay the bill.
“That’s in one school system,” said state Sen. Tom Sawyer (D-Akron). “This is not unique to Akron ... The backlog is long, large and mounting.”
Since 2005, Akron has moved roughly $5 million that otherwise would have gone to classroom instruction and general expenses to fund reimbursable special education services mandated by the state, including occupational and physical therapy, nursing, mental health services, and evaluations or assessments. Meanwhile, the state postpones year-end Medicaid reimbursements.
That’s $935,000 for services rendered in the 2009-10 school year, $384,000 for the next year, $850,000 for the 2011-12 school year, another $850,000 for last year. From 2005-09, the state reimbursement program was in limbo, and Akron spent about $500,000 annually that otherwise would have been reimbursed, according to estimates provided by the school and its contracted health-care billing agent.
Some schools have dropped out of the program. After weathering large reductions in state operating aid in the last three years, they can’t afford the staff to manage paperwork for a program that no longer offers a return, says Bryan Williams, a State Board of Education member whose district covers a five-county area west of Akron.
To qualify for reimbursement, the districts also must hire a public accountant to verify the expenditures, which adds to the up-front costs while waiting for reimbursement that never comes.
“I’m frustrated,” Williams said. “I think the schools are even more frustrated. It is real money.”
If the money is ever paid, “This is going to be a significant lump-sum windfall for districts as they struggle,” he said.
As each day passes, schools lose.
“Medicaid providers typically have 365 days from the date of service to make a claim,” Sam Rossi, spokesman for the Ohio Department of Medicaid, said in an email. Rossi noted that each claim requires federal approval.
That means that even if the Medicaid program is expanded to include additional items, there is an expiration date on year-old claims, including the $700,537 spent each month in Akron for teaching aides, and another $333,314 spent on special education transportation.
Proponents of program expansion say schools are spending precious dollars that could be covered by the school Medicaid program, not to be confused with the other state Medicaid system designed for low-income residents.
“There are a couple of items that Ohio has chosen not to be billable for,” said Paul Kidd, director of student support services at Medina City Schools. Kidd said Medina misses out on thousands of dollars annually because Ohio does not participate in reimbursement for special education transportation and nursing aides. Other states do, among them Michigan and Texas.
“For us in the cash-strapped districts, it seems only reasonable that we would participate to the extent that other states do,” Kidd said. “That would make a big difference for us, especially those personal aides.”
Hold-up on expansion
Before the state can expand its program, it must reconcile $50 million in outstanding end-of-year payments dating back to the 2009-10 school year.
During the 2005-09 period, the program was in disarray and millions in payments did not happen. A suit by the large urban districts, among them Akron and Cleveland, resulted in a new system, the Medicaid School Program, launched in 2009 to serve public and charter school students.
But Medicaid billing agents have said the new program continues to flounder.
In February, the Beacon Journal reported that $50 million in claims just since 2009 are outstanding.
The only progress since then appears to be meetings.
“It was really the impression of the state school board that things were going to move forward. This was back in late April or May. Nothing has happened,” said Chris Meroff, executive director of Texas-based MSB Connections, a health-care billing agency that handles claims for schools. “We’re restarting those conversations now, mainly because there is no movement.”
In the spring, Meroff urged lawmakers and state officials into expanding the program to cover additional services.
Williams was privy to those conversations.
“Well, sadly there is no progress to report. Promises and expectations have been created. But there were no results,” said Williams, who plans to speak with the director of the Ohio Medicaid office on Oct. 12. “We’ve had a lot of promises. Still there are no checks coming out to schools.”
Meanwhile, billing agents say an error in the state’s Medicaid distribution system has held up some $50 million that was to be delivered during the summer, but has been delayed to December. Rossi at the Medicaid office explained: “Coding changes within the Medicaid Information System Technology System (MITS) are required before payments can be made. We are on track to have these changes made by December.”
Value of expansion
According to Meroff, whose firm would benefit from an expansion of Medicaid coverage, schools could be receiving an additional $200 million.
School officials, however, aren’t hopeful.
“Even if they do expand it, I doubt that we would get all of that. But anything we can get would greatly help us service the students,” said Kidd with Medina schools.
If the program is expanded, Williams suspects that some of the districts that have dropped out will jump on board, enticed by reimbursements that are worth their while to claim.
“It’s huge. Hundreds of millions of dollars,” Williams said. “It’s [money] that the districts are going to spend — that they’re going to forego getting back — that the state treasury doesn’t have to match one dollar. … Everything we get is going to be a net plus for the state and require no general fund match.”
Rossi cautioned, however, “No decisions have yet been made to expand the program to include additional services.”
Meanwhile, Akron awaits some kind of settlement in December for costs back to 2005.
“We have never to this day received any of our cost report payments from the state, from the Ohio Department of Job and Family Services or the Ohio Medicaid School Program,” Tish Kwiatkowski, autism/special education consultant for Akron schools, said. “We have still never been paid. And we could use that money.”
Doug Livingston can be reached at 330-996-3792 or firstname.lastname@example.org.