A Medicaid Reimbursement Program in Colorado Schools

Article excerpt

Anyone who works in a school setting understands the relationship of student health to academic achievement. Healthy students can achieve a higher academic level than can unhealthy students. Unfortunately, financial considerations often force schools to choose between health and academics. This dilemma becomes particularly acute as states mandate standards and assessment efforts to improve student achievement.

Through efforts of the Colorado School Medicaid Consortium (CSMC), Colorado school districts and Boards of Cooperative Education Services (BOCES) have access to federal resources to support students' health needs. CSMC is a non-profit corporation, the first of its kind in the nation, formed under the leadership of the Denver Public Schools to help implement and manage the state's school Medicaid reimbursement program. Consortium members include school administrators, school health professionals, parents, community health professionals, and representatives of professional organizations, state agencies, and the state legislature. CSMC efforts to shape legislation such as "Health Services - Provision by School Districts (CRS 26-4-531)" allow any school district or BOCES to receive federal matching funds for amounts spent in providing health services to children receiving Medicaid benefits. Districts/BOCES are eligible to receive partial Medicaid reimbursement for six categories of health services as listed in the state plan amendment:

* Health Encounter - EPSDT (Partial Early Periodic Screening Diagnosis and Treatment). May include child-health history; physical exam; hearing, vision, or dental screening; developmental, nutritional, or social assessment, follow-up and referral; indicated screening tests and referrals; screening for appropriate immunizations; health education and anticipatory guidance; and screening and triage of childhood illnesses.

* Diagnostic Activities (Interperiodic Screens). Includes scoring, written summaries, and consultation necessary to complete formal testing, assessment, and evaluation activities, but not academic testing.

* Direct EPSDT Services. Provided for maximum reduction of a physical or mental disability and restoration to the best possible functional level through physical therapy, occupational therapy, and speech, hearing, and language service. Also provides direct services for a specific developmental disorder or delay, emotional/behavioral problems, or speech, language, hearing, or vision disorders.

* Special Transportation. To and from a child's residence and the school and/or the service site on the day a Medicaid-covered service provided for direct services listed in a child's Individual Education Plan (IEP), Individual Family Services Plan (IFSP), or Section 504 Accommodation Plan; and to EPSDT screens provided during the normal school day at nonschool locations.

* Administration of Immunizations. For children at risk of suspension from school for lack of mandatory immunizations or in response to a public health emergency.

* Targeted Case Management. To enable individuals ages 0-21 eligible for school-based targeted case management under the state plan to access needed medical, social, educational, and other services.

QUALIFIED MEDICAID SERVICE PROVIDERS

Medicaid requires services to be delivered by "qualified health care professionals operating within the scope of his/her practice" who meet state or national requirements for licensure, registration, or certification as a health care professional. In Colorado, eligible providers include audiologists; health technicians (delegated by a nurse, OT, or PT); licensed professional counselors; nurses; occupational therapists (OT); orientation and mobility specialists; physical therapists (PT); psychologists; social workers; speech language specialists; and special educators (targeted case management services only).

REIMBURSEMENT BASIS

School expenditures for costs of health and related services provided to Medicaid-eligible students are federally matched at 50% for Colorado -- the minimum matching level. …