United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-04-05 monographic deposited born digital 62 p. GA 1.13:HEHS/OSI-00-69 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-OSI-00-69 P0b002ee1803896a5 f:h600069 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-OSI-00-69 machine generated eng fdlp REPORT GAOREPORTS-HEHS-OSI-00-69 HEHS/OSI-00-69 Children Allowable costs Program abuses Health insurance School health services Administrative costs State-administered programs Cost sharing (finance) School districts Internal controls Medicaid Program Illinois Massachusetts Michigan Early and Periodic Screening, Diagnosis, and Treatment Program HHS Individuals With Disabilities Education Act Program New York Letter Report HEHS OSI

Pursuant to a congressional request, GAO provided information on states' practices regarding Medicaid reimbursement of school-based administrative activities, focusing on: (1) the extent to which school districts and states claim Medicaid reimbursement for school-based health services and administrative activities; (2) the appropriateness of methods states use to establish bundled rates for school-based health services and assess the costs of administrative activities that their schools may claim as reimbursable; (3) states' retention of federal Medicaid reimbursement for services provided by schools and schools' practice of paying contingency fees to private firms; and (4) the adequacy of the Health Care Financing Administration's (HCFA) oversight of state practices regarding school-based claims, including safeguards employed to ensure appropriate billing for health services and administrative activities.<p/>GAO noted that: (1) nearly all states reported Medicaid expenditures for school-based activities, which totalled $2.3 billion for the latest year of available state data; (2) the majority of payments--about $1.6 billion--were for health services provided by schools in 45 states and the District of Columbia, and about $712 million was for administrative activities billed by schools in 17 states; (3) three states--Illinois, Michigan, and New York--accounted for over 60 percent of total school-based claims; (4) New York accounted for 44 percent of all health services payments, while Illinois and Michigan together accounted for 74 percent of all administrative activity payments; (5) Medicaid payments to schools ranged from a high of nearly $4820 per Medicaid-eligible child in Maryland to less than 5 cents per child in Mississippi, reflecting in part variation in the proportion of states' school districts that submitted claims for Medicaid services and activities; (6) some of the methods used by school districts and states to claim reimbursement for school-based services do not ensure that health services are provided, or that administrative activities are properly identified and reimbursed; (7) bundled rate methods used by school districts to claim Medicaid reimbursement for school-based health services have failed in some cases to take into account variations in service needs among children and have often lacked assurances that services paid for were provided; (8) in two states, monthly payments ranging from $141 to $636 per child were made to schools soley on the basis of at least 1 day's attendance in school, rather than on documentation of any actual service delivery; (9) with regard to administrative activities, poor controls have resulted in improper payments in at least two states, and there are indications that improprieties could be occurring in several other states; (10) Medicaid costs shared by the federal government and the states could fall under one of the two following categories: (a) medical assistance; and (b) administrative duties; (11) each state program's federal and state funding shares of health services payments are determined through a statutory matching formula; (12) this formula results in federal shares that range from 50 to 83 percent, depending on a state's per capita income in relationship to the national average; and (13) over 95 percent of Medicaid's $177 billion in total expenditures in FY 1998 was spent on health services. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-OSI-00-69/html/GAOREPORTS-HEHS-OSI-00-69.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-OSI-00-69/pdf/GAOREPORTS-HEHS-OSI-00-69.pdf GAO/HEHS/OSI-00-69 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-OSI-00-69 Letter Report GAO/HEHS/OSI-00-69; Medicaid in Schools: Improper Payments Demand Improvements; Children Allowable costs Program abuses Health insurance School health services Administrative costs State-administered programs Cost sharing (finance) School districts Internal controls Medicaid Program Illinois Massachusetts Michigan Early and Periodic Screening, Diagnosis, and Treatment Program HHS Individuals With Disabilities Education Act Program New York Title 20 Section 1400 Title 20 Section 1412(a)(5)(A) 20 U.S.C. 1400 20 U.S.C. 1412(a)(5)(A)