Medi-Cal Programs

ABOUT SCHOOL-BASED MEDI-CAL

In 1989, Congress enabled school districts to claim federal funds for health related services they provide to students enrolled in Medicaid. Districts can seek reimbursement from Medicaid for these services as long as the district is a Medicaid provider and meets requirements regarding licensure, certification, and other federal mandates for the Medicaid program.

Another federal law, the Individuals with Disabilities Education Improvement Act commonly known as IDEA, authorizes federal reimbursement for health related services specified in a Medicaid-eligible child’s IEP.

Medicaid is called Medi-Cal in California. California established its Local Education Agency (LEA) Billing Option Program in 1993 and it’s Medical Administrative Activities Program (MAA) in 1994.

These two distinct Medi-Cal programs have the responsibility to recover costs from the federal government to offset the expenses of existing programs and to fund supplemental health and human services:

The Contra Costa County Office of Education provides support for both the LEA Billing and MAA programs. These reimbursement programs can support your continued efforts in providing effective and quality health programs for students.

LOCAL EDUCATION AGENCY (LEA) MEDI-CAL BILLING OPTION PROGRAM

The Local Education Agency (LEA) Medi-Cal Billing Option Program is a fee-for-service program authorized by state and federal governments. In 1986 Congress authorized schools to bill the Medicaid (note: in California, Medicaid is called Medi-Cal) program for some health related services. Services reimbursed by Medi-Cal currently include certain health services for all students in the district as well as specific services for students with disabilities. The health related services for students with disabilities include both assessment and the treatment(s) specified on a student’s Individual Education Program (IEP) including audiology, counseling, nursing services, occupational therapy, physical therapy, speech therapy, and transportation related to these services. Medi-Cal regulations set the same high professional standards for school-based providers as providers who work in hospitals, rehabilitations centers, and other settings.

As per the Individuals with Disabilities Education Act (IDEA) regulations, school districts provide all required services as specified on a child’s IEP at no cost to parents. However, school districts can be reimbursed for a percentage of the cost of those services from the federal government’s Medicaid program which increases the ability to provide health related services for all students.

For more information on the LEA Medi-Cal Billing Option Program please please visit the Department of Health Care Services (DHCS) website

MEDI-CAL ADMINISTRATIVE ACTIVITIES PROGRAM

The Contra Costa County Office of Education has been involved in the Medi-Cal Administrative Activities (MAA) program since 1999.

The County Office is the host entity for the Bay Region (Region 4) Local Educational Consortium (LEC) statewide MAA program. Region 4 is based on the California County Superintendent Educational Services Association (CCSESA) regions and serves Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo and Solano counties.

The MAA program allows school districts and county offices to be reimbursed federal dollars for costs incurred while performing certain administrative activities. Employees' record the time worked on these activities for one week each quarter, and then a claim is submitted based on the activities performed.

Administrative activities that facilitate enrollment into Medi-Cal and assisting students and families to access Medi-Cal services such as:

  • Outreach–Providing Medi-Cal information to students and their families. Initial referral of students to medical services.

  • Facilitating Applications-Referring or assisting families with the Medi-Cal application.

  • Monitoring, Coordination, or Referral to Medi-Cal covered services-Such as; speech, occupational therapy, physical therapy, counseling, and any follow-up on these issues.

  • Arranging Transportation to medical services within the community or IEP services at the school site.

  • Translation-Arranging or providing translation for medical services, e.g. speech, counseling.

  • Program Planning. Policy Development & Interagency Coordination-Developing strategies to improve the delivery or coordination of medical services.

Allowable costs may include the salaries and benefits of the staff performing the activities, applicable operating expenses, and appropriate overhead expenses. MAA is a Federal Financial Participation (FFP) program, which requires a non-federal match. Approved MAA costs are reimbursed at fifty percent (50%). Revenue is unrestricted!

For more information on the Medi-Cal Administrative Activities Program please visit the Department of Health Care Services (DHCS) website

CONTACTS

TITLE NAME (click to email) PHONE FAX
Supervisor, Medi-Cal Programs Michelle Cowart (925) 942-5391 (925) 942-5360
Division Project Specialist, Medi-Cal Programs Maureen Skiba (925) 942-3340 (925) 942-5360
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