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TUSD Medi-Cal outreach claims merit investigation

“Unreasonable” and “unallowable” were just two words used to characterize claims made by Turlock Unified School District in its endeavor to collect reimbursement for referring low-income students to Medi-Cal through the Medi-Cal Administrative Activities program.

As a result, the District could potentially be receiving less in terms of reimbursement than expected, although no final award amount has been revealed according to TUSD Superintendent Sonny Da Marto.

“Obviously, we are disappointed with the decrease in anticipated funding,” said Da Marto. “Nonetheless, we will continue to make the necessary adjustments based on Local Education Consortia, California Department of Health Care Services, and Centers for Medicare and Medicaid Services feedback as we have in the past and present to remain compliant with all MAA program regulations and guidelines to best serve our most needy students and families."

The school district didn't seek  reimbursement for directing low-income students to Medi-Cal until after a 2005 audit report which revealed that $57 million in federal funds was left unclaimed in 2002-2003 from the MAA program due to school districts not pursuing reimbursement.

As a result, TUSD, along with a myriad of other California districts and school programs, began to vie for compensation through MAA, which gives school districts federal reimbursements for 50 percent of the cost of referring low-income students to the health care program.  

However, instead of receiving an influx of reimbursements as was expected, TUSD became the subject of a 2013 financial management review with two other entities — Tulare County Office of Education and Santa Barbara County Office of Education’s special education program.

According to the review, the DHCS claimed $3.4 million in federal financial participation relating to invoices for school-based administrative expenditures incurred for TUSD— the most out of all claiming units in California in the 2011 State Fiscal Year.

Additionally, the report took into consideration the normal job duties of the participants who claimed that they spent a significant amount of time copying, discussing, and distributing Medicaid outreach materials, since many of the participants were primarily employed to “provide school instruction and implement the academic curriculum, not provide Medicaid education.”

“Given that the position of the participants were mainly for education purposes, it does not seem reasonable that 15 percent of the time spent on activities would qualify for Medicaid reimbursement,” the report stated. “Most of these staff in the survey included regular education teachers so it was unreasonable that 15 percent of their time would be on Medicaid outreach and enrollment activities.”

Despite these findings, Da Marto reports that the District has followed the instructions of LEC and 2005 California State Audit Recommendations for the past 15 years, and as a result has unequivocally maximized the opportunity for staff participation in MAA outreach activities.

“Throughout the tenure of participating in the MAA program, TUSD has continued and will continue, to make adjustments based on changes in MAA regulations with guidance provided by LEC (SCOE),” said Da Marto. “TUSD has continued to receive ‘compliant’ marks on all compliance reviews (audits) since the inception of the MAA program because of the collaboration and program oversight provided by Janice Holden at SCOE and her diligence in helping TUSD in revising our reports based on the direction provided by the state."

Overall, the report stated that the DHCS claiming process was found to be incompliant, causing the federal agency to temporarily suspend payment on Medi-Cal administrative claims in 2011 and 2012.

To continue payment, the state has been required to construct a new method to calculate Medi-Cal administrative expenses by the first of this month.