Contract Medicaid Billing Services for Component Districts
MESD Medicaid billing staff also processed claims for component districts including Centennial SD, David Douglas SD, Gresham-Barlow SD, Parkrose SD, Portland Public Schools and Reynolds SD.  Beginning in School Year 2009-2010 districts received their own revenue and handled all their own financial transactions. MESD services to districts include training component district medical staff, business manager and staff, as well as tracking and monitoring services and claims, and reporting program information to Special Education and Student Service Directors at the monthly HSS Advisory Council. 

Districts do well in Medicaid Audits
For purposes of maintaining records in the event of a Medicaid audit, MESD Medicaid Billing staff also store District billing information electronically in a HIPAA-compliant environment as well as on paper. Districts are required to maintain all supporting information related to the services they provide and bill to the State Medicaid Agency.  State of Oregon Medicaid auditors began audits on Gresham-Barlow SD, Parkrose SD and Reynolds SD in May 2008.  These audits were completed in June 2010.  No district paid back more than $120 for audit findings.  Revenue generated for these three districts during the audit year totaled over $300,000.

Program Changes by Federal and State Governments
There were few regulatory or technology changes during this school year. This stabilized the program activity for the first time in several years.  The new Early Childhood  Targeted Case Management program which was to begin in September of 2009, was delayed for a second year due to ongoing dialogue and unresolved issues between the

State Medicaid Agency and the federal Centers for Medicare and Medicaid, the authorizing agencies of the Medicaid program in Oregon.

Because of Oregon's double-digit unemployment, the Federal Medical Assistance Percentage (FMAP) for Title XIX (Medicaid) is now 72.61%. This means public schools’ current local match portion for these services is 27.39% and the Oregon Department of Human Services receives 72.61% federal match which is nearly 12% higher matching rate than at any prior year and brought an additional $375,560 in Medicaid matching funds to Multnomah County school districts.  This additional match is stimulus funded. These dollars are additional reimbursement revenue to Oregon schools; Medicaid dollars are a prior revenue source to education dollars under IDEA, as long as districts participate in the Medicaid reimbursement program.  As Oregon’s economy continues to lag, another outcome is that more and more children have become Medicaid/OHP eligible--resulting in greater reimbursement potential for public schools.  As the 2009 -2010 school year began with 33% of the students covered by Medicaid; it ended with over 44% of the students covered by Medicaid. Medicaid (public) health insurance is also known as the Oregon Health Plan or by the newer program name passed on July 1, 2009—Healthy Kids.

Contract Medicaid Billing Services for Districts outside MESD service area

• Contract Districts not in Multnomah County continue to utilize MESD’s Medisync management/billing system, technology that allows Public Schools to capture, store, validate and submit claims electronically.  Through contracts with districts outside MESD’s service area, MESD provides technical support and billing technology for several school districts, Early Childhood, Regional Programs and ESDs.  These districts reside in Deschutes, Crook, Hood River, Umatilla, Lane, Clackamas and Tillamook Counties.  In spite of the several districts that no longer participate in the Medicaid School-Based reimbursement system, those who do depend on MESD to identify technology changes and manage the necessary upgrades. These districts grossed a total of $ 592,401 in Medicaid reimbursement.   Medicaid Billing services are self-sustaining. 

Medicaid Administrative Claiming (MAC)
Under an Intergovernmental Agreement, MESD acts as the agent for this Medicaid Leveraging Program for Local Educational Entities.  MAC is a function “found necessary for the proper and efficient administration of the State Medicaid Plan.”  This process is accomplished by OMAP reimbursement for activities allowable by federal guidance and time accounting.

Below is a listing of the local school districts and agencies that participate in MESD’s MAC program.  As local districts look harder to find revenue to support programs, we have added two new districts to the MESD MAC family from central and eastern Oregon in the spring of 2010.

  
 
Net Medicaid Administrative Claiming (MAC)
January 1, 2009 – December 31, 2009