The fiscal disaster that is Claremont School District SAU 6 has been making the news recently, the story of a school board facing the righteous anger of parents and taxpayers who have found their faith, and their tax dollars, sadly misplaced. And while this particular disaster appears to have several contributing factors that are still unfolding, NH taxpayers absorbing this news should take the opportunity to ask questions of their own school boards, and about a source of funding that is not as transparent as it would seem.
The Funding Source: NH Medicaid to Schools offers reimbursement to enrolled schools providing medical services to eligible students (those with IEPs and medical diagnoses and a demonstrated need for services) under NH DHHS Rule He-W 589. This means the State will reimburse a school a set amount (50 percent of the rate ) per session for services such as PT/OT or a paraprofessional for a child with autism or a nurse for a child with a tracheotomy.
All right, that’s not new news. What’s the point? Special education funding has been around forever.
The Issue: Did you know that not all schools in NH actually bill Medicaid, or bill for all eligible services? Some are enrolled and simply don’t bill, while others aren’t even enrolled as a potential provider. NH Medicaid to Schools is a voluntary program, where both the school providers and students/parents themselves can opt out of seeking reimbursement from federal funding for services provided by the school (He-W 589.01).
Covered services eligible for reimbursement through the federally matched reimbursement include Early Periodic Screening, Diagnosis and Treatment Programs (EPSDT) which are federally mandated, as well as the following: nursing, physical therapy, occupational therapy, speech therapy, rehabilitative assistance (paraprofessionals, including personal care), mental health, psychological services, psychiatric services, vision and hearing, and transportation. If a student has a medical diagnosis and Medicaid, and doesn’t fall into the funding category of another waiver or program, Medicaid reimburses for services provided through the school. However, if schools are not seeking reimbursement for these services (which they are federally and legally required to provide to students), then who is paying for them?
What does this mean? If services are being provided but not billed for reimbursement, then money is being left on the table. Costs that are then passed on to others to cover, such as local property owners paying property taxes. NH has 105 SAUs, and in 2018, NHPR reported that 63 percent of school districts were participating in NH Medicaid to Schools. Participating, which implies they are enrolled in Medicaid but does not necessarily mean they were or are billing. This number does not include charter or private schools.
NH taxpayers can, and perhaps should, ask questions of their local school districts.
Ask if they participate in Medicaid to Schools.
How many students did they have enrolled last school year in Medicaid to Schools, and how much did their services end up costing? Some schools may say the number is hard to define, citing children who go in and out of Medicaid eligibility monthly, but there should be a relatively predictable number. A good budget development will include projected special education costs, and there should be at least an expectation of reimbursement.
Of these costs, how much did Medicaid to Schools cover? For example, if the total cost of medical services for Medicaid to school-eligible students was $650,000, did they bill all $650,00, and if so, how much of this amount was paid back? Note that, as previously stated, the federal match is 50 percent, so the reimbursed amount should equal half of what was billed.
What barriers exist to billing Medicaid and being fully reimbursed for eligible services? Is there a dedicated biller handling claims? Many SAUs use a contracted billing agency; are they reputable and producing the results they are paid for? Are there complaints that the documentation standards are too time-consuming for already overstretched staff? A perusal of the Medicaid to Schools Technical Assistance Manual indicates that the standards for documenting services provided are not burdensome and are in keeping with the standard of care for any provider. A rule of thumb for any provider of healthcare services is to keep a record of whether they are being done and whether they are being submitted in a timely manner (within 12 months of the date of service) for reimbursement.
Get an idea of whether they are billing Medicaid, and, if so, ask for hard numbers to confirm they are billing for all services provided. Suppose a biller at a school district can’t do the math to calculate the billable transportation rate for each student on days when they have provided covered medical services at school. In that case, they may be tempted not to bill for the transportation cost. But that adds up. Bus rides for eligible students can be reimbursed at a calculated rate laid out in the Medicaid to Schools Technical Assistance Manual and He-W 589, but this is only on days that they receive a Medicaid-covered service at school (ie, they are receiving PT/OT that day, or have a session with a rehabilitative assistant).
The case of Claremont SAU 6 brings this point into question. Some SAUs may say they bill Medicaid to Schools but may not engage in a transparent process to discuss barriers to billing and the percentage of eligible services they bill through Medicaid. Simply checking a box that Medicaid to Schools is being billed is not sufficient, as a considerable sum of money may be left on the table due to incompetence, a lack of understanding of regulations, and other factors. Schools should be encouraged to show their numbers to taxpayers, identifying that they have exhausted all other payment sources before passing costs on to NH taxpayers.
NH taxpayers would be well served to raise questions with their local school boards to improve accountability and transparency, and to ensure that all available funding sources are utilized before costs are passed on to local taxpayers. Children deserve the medical services they are legally entitled to receive. Taxpayers and parents alike deserve that their trust in local school administrations be repaid by these services not only being delivered but also being reimbursed through the appropriate funding sources before being passed on for local taxpayers to cover.
Authors’ opinions are their own and may not represent those of Grok Media, LLC, GraniteGrok.com, its sponsors, readers, authors, or advertisers.
Got Something to Say, We Want to Hear It. Comment or submit Op-Eds to steve@granitegrok.com
Author bio: JJ Elliott is a well-traveled NH native with an eclectic background in healthcare, government, and human services. Unapologetically questions authority of any sort.
https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/nhmedicaidtoschoolstaguidefinal.pdf
https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-schools
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”& HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”CVID=oE4MyPE” HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”& HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”& HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”CVID=oE4MyPE” HYPERLINK
https://nhmmis.nh.gov/portals/wps/wcm/connect/d6c8fb29-9ef1-4713-a6ce-e79db30e89ad/NHCSR-OMBP-3-Provider-Medicaid+to+Schools+Manual+8-8-2023-Att1-20230808.pdf?MOD=AJPERES&CVID=oE4MyPE”CVID=oE4MyPE
https://www.nhpr.org/nh-news/2018-08-22/after-long-wait-dhhs-expands-medicaid-to-schools-for-student-health-care
