New York Schools Fail to Get Medicaid Money for Special-Needs Services

AppId is over the quota
AppId is over the quota

State Health Department data from 2006 to 2010 show that education-related claims by the city were 60 percent lower last year than they were five years ago. And virtually all of the $302 million in Medicaid reimbursements the city did receive during that period were for administrative claims that, under the rules that took effect in September 2009, are no longer eligible for reimbursement.

New York, where more than two-thirds of the 168,000 special-needs students are poor enough to qualify for Medicaid, has lagged far behind the state’s other large school districts in filing claims. In fact, the city’s Education Department filed no claims related to nursing services, occupational and physical therapy, psychological counseling, audiological evaluations or transportation between 2006 and 2010; meanwhile, Buffalo, Rochester, Syracuse and Yonkers — where the combined special education populations are less than 10 percent of New York City’s — were reimbursed $77 million for such services.

The city’s Education Department did not try to file thousands of claims in the 16 months immediately after the new rules were announced, the state records show. A spokeswoman said it was because the department lacked the staff and the training to handle the more demanding requirements. (Data for 2011 was not available.) Claims can be filed for up to 24 months after the service is provided, but much of the required material cannot be retroactively documented.

“The Medicaid reimbursement process has become increasingly cumbersome,” the spokeswoman, Barbara Morgan, said.

Ms. Morgan said a city analysis found that the Education Department did not have proper documentation for all but 9,000 students during the 2007-8 and 2008-9 school years, a period covered retroactively by the new rules. The analysis shows, however, that even for those students, almost 20 percent of the $10 million in claims filed were rejected for not meeting the new criteria.

In September, for the first time since 1988, when Congress allowed school districts to file for Medicaid reimbursements, the city put a manager in charge of handling the claims exclusively, one of several recent changes intended to improve collections.

“We aggressively pursue reimbursements,” Ms. Morgan said, “and are working towards a long-term, streamlined solution that will allow us to receive money available to our students.”

The new rules are part of a settlement in which New York City agreed to repay the federal government $100 million — and the state $332 million — after a 2005 audit unearthed myriad irregularities in its claims. They require school districts to file claims much as medical clinics do. For example, doctor’s orders must accompany individual claims, and districts must use specific codes for the types of services they provide. In addition, therapists are now required to hold higher levels of certification — levels which half of New York City’s speech teachers lack — and districts must provide annual training, and hire compliance officers.

Other school districts are also struggling. Since counseling sessions led by guidance counselors and social workers are no longer eligible for reimbursement, Syracuse recently hired two licensed therapists, at a cost of $250,000. Even so, the district has been able to file only about one-quarter of the claims it once did, its chief financial officer, Suzanne Slack, said.

“The new regulations nearly crippled us,” Ms. Slack said.

But at a time of tight budgets and grim economic forecasts, many districts and states — each with its own set of filing rules — have invested heavily in compliance. Bruce Hunter, associate executive director for policy at the American Association of School Administrators, said the reimbursements, generally from 50 percent to 70 percent of the cost of a service, had become “an enormous help to school districts” across the country.

In New Jersey, where the state treasury retains 65 percent of the reimbursements, filing the claims has been mandatory since 2008, and the state has set precise goals for its districts, including a 90 percent return rate on forms giving parental permission for schools to file on a child’s behalf. In Washington, Mayor Vincent C. Gray asked the accounting firm Deloitte in February to suggest, among other things, ways to improve the system used by local schools to apply for reimbursements.

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State House Journal: Medicaid Cuts Are Part of Larger Battle in Maine

AppId is over the quota
AppId is over the quota

Yes, he could. “If you come across from New Hampshire at 8 o’clock in the morning, by 4 o’clock in the afternoon you will have subsidized housing in the state of Maine,” the governor declared. “We need to change the rules.”

Mr. LePage, a first-term Republican whose destitute childhood is a well-known piece of his biography, is seeking to do just that. Calling the state’s entitlement system “a runaway train,” he has proposed contentious changes, including some of the most drastic Medicaid cuts in the nation.

This month Mr. LePage announced a plan to reduce Maine’s Medicaid rolls by 65,000 people — about 18 percent of the total. He is asking the Republican-controlled Legislature to make childless adults and all 19- and 20-year-olds ineligible for the program, known as MaineCare, and to tighten income requirements for parents. He also wants to eliminate an array of optional benefits, including dental care and room and board at assisted living centers.

Hundreds of people descended on the State House last week to protest the cuts, which Mr. LePage says are crucial not just to put the state on sound financial footing but to change a national perception that Maine, more than most states, encourages dependency.

“The issue is basically fairness and equity,” Mr. LePage said at the town hall meeting in Salem Township, where he answered pre-screened questions from a polite crowd of about 100. “We have a very small population of people who pay their taxes, want an efficient government, and they are very generous in wanting to help. What they do not like is people taking advantage of the system.”

With his combative style, Mr. LePage, the first Republican to win the governor’s office here in two decades, has brought more tumult to Augusta than the low-key capital has seen in years. Soon after his inauguration in January, he clashed with the state’s N.A.A.C.P. leaders after they questioned why he had declined invitations to meet with them. In March, he ordered a mural depicting Maine’s labor history removed from a state building, saying it was too favorable to unions.

With his fellow Republicans in the Legislature, who last year won control of both chambers for the first time since the 1970s, Mr. LePage cut taxes by $150 million, streamlined regulations and pushed for a right-to-work bill, with the goal of drawing more businesses and higher-income residents to Maine.

The Medicaid battle will be his biggest fight to date. Even if the Legislature approves Mr. LePage’s Medicaid cuts, the federal government could reject some of them. The new federal health care law prohibits lowering Medicaid eligibility, and only a few states have received waivers to do so on a limited basis.

Responding to questions in a news conference at the State House about whether the cuts might fall afoul of federal law, Mr. LePage said, “Well, put me in jail, and we will go from there.”

Mr. LePage declined, through a spokeswoman, to be interviewed for this article.

The state’s Department of Health and Human Services, which administers the program, is facing a $221 million budget shortfall. But Democrats maintain that the gap is due more to poor planning by the LePage administration than to growth in Medicaid enrollment and that Mr. LePage is using a false pretense to push an ideological agenda. His administration has said that enrollment growth accounted for only $6.5 million of the shortfall.

“This is absolutely about philosophy,” said State Representative Emily Cain, a Democrat from Orono who is the House minority leader. “The governor has taken every opportunity to try to build up the perception that MaineCare is fraught with fraud when in fact it’s not.”

Kevin Raye, the Republican president of the State Senate, said he agreed with Mr. LePage that Maine was overly generous with public benefits and needed to pull back. “It was expanded by design, and I really think it’s part of the reason the Democrats lost their majority in Maine,” Mr. Raye said. “We need to make sure the folks who are the most vulnerable are the priorities: those with disabilities, poor elderly and children.”

According to the Kaiser Family Foundation, 27 percent of Mainers were covered by Medicaid in 2008, the most recent year for which complete data is available, compared with 20 percent of the population nationally. Only California and the District of Columbia had higher percentages enrolled, the foundation said. ?

?Maine’s spending on Medicaid is also higher than the national average, according to the National Association of State Budget Officers: it spent 28.6 percent of its budget on Medicaid in 2010, the group found, compared with 22.3 percent nationally.

?Last week, lawmakers heard testimony from several hundred people who oppose the cuts, including Medicaid recipients, advocates, doctors and owners of assisted living facilities that might close if the cuts are approved. The Maine Center for Economic Policy, an independent nonprofit group, said the cuts would eliminate more than 4,000 jobs around the state, and the Maine Hospital Association said that hospitals would lose at least $30 million in state and federal payments.

Pauline Gudas of Lewiston testified that she would have to quit her job to care for her elderly mother if the cuts passed because Medicaid would no longer pay for her assisted living facility. But Ms. Gudas, 55, said she had voted for Mr. LePage and agreed with him that the state was too generous.

“There needs to be changes, and I absolutely understand that,” she said.

But David Neverland of Benton, who is disabled and would lose a portion of his health care coverage under the plan, said that because Mr. LePage had pulled himself out of poverty and succeeded in life, he unfairly expected the same of all poor Mainers.

“He seems out of touch with what the reality is here,” said Mr. Neverland, 58. “This is a state of poor people, and most of us who get this support, 95 to 97 percent of us, really need it.”

Murray Carpenter contributed reporting.

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New York Schools Fail to Get Medicaid Money for Special-Needs Services

AppId is over the quota
AppId is over the quota

State Health Department data from 2006 to 2010 show that education-related claims by the city were 60 percent lower last year than they were five years ago. And virtually all of the $302 million in Medicaid reimbursements the city did receive during that period were for administrative claims that, under the rules that took effect in September 2009, are no longer eligible for reimbursement.

New York, where more than two-thirds of the 168,000 special-needs students are poor enough to qualify for Medicaid, has lagged far behind the state’s other large school districts in filing claims. In fact, the city’s Education Department filed no claims related to nursing services, occupational and physical therapy, psychological counseling, audiological evaluations or transportation between 2006 and 2010; meanwhile, Buffalo, Rochester, Syracuse and Yonkers — where the combined special education populations are less than 10 percent of New York City’s — were reimbursed $77 million for such services.

The city’s Education Department did not try to file thousands of claims in the 16 months immediately after the new rules were announced, the state records show. A spokeswoman said it was because the department lacked the staff and the training to handle the more demanding requirements. (Data for 2011 was not available.) Claims can be filed for up to 24 months after the service is provided, but much of the required material cannot be retroactively documented.

“The Medicaid reimbursement process has become increasingly cumbersome,” the spokeswoman, Barbara Morgan, said.

Ms. Morgan said a city analysis found that the Education Department did not have proper documentation for all but 9,000 students during the 2007-8 and 2008-9 school years, a period covered retroactively by the new rules. The analysis shows, however, that even for those students, almost 20 percent of the $10 million in claims filed were rejected for not meeting the new criteria.

In September, for the first time since 1988, when Congress allowed school districts to file for Medicaid reimbursements, the city put a manager in charge of handling the claims exclusively, one of several recent changes intended to improve collections.

“We aggressively pursue reimbursements,” Ms. Morgan said, “and are working towards a long-term, streamlined solution that will allow us to receive money available to our students.”

The new rules are part of a settlement in which New York City agreed to repay the federal government $100 million — and the state $332 million — after a 2005 audit unearthed myriad irregularities in its claims. They require school districts to file claims much as medical clinics do. For example, doctor’s orders must accompany individual claims, and districts must use specific codes for the types of services they provide. In addition, therapists are now required to hold higher levels of certification — levels which half of New York City’s speech teachers lack — and districts must provide annual training, and hire compliance officers.

Other school districts are also struggling. Since counseling sessions led by guidance counselors and social workers are no longer eligible for reimbursement, Syracuse recently hired two licensed therapists, at a cost of $250,000. Even so, the district has been able to file only about one-quarter of the claims it once did, its chief financial officer, Suzanne Slack, said.

“The new regulations nearly crippled us,” Ms. Slack said.

But at a time of tight budgets and grim economic forecasts, many districts and states — each with its own set of filing rules — have invested heavily in compliance. Bruce Hunter, associate executive director for policy at the American Association of School Administrators, said the reimbursements, generally from 50 percent to 70 percent of the cost of a service, had become “an enormous help to school districts” across the country.

In New Jersey, where the state treasury retains 65 percent of the reimbursements, filing the claims has been mandatory since 2008, and the state has set precise goals for its districts, including a 90 percent return rate on forms giving parental permission for schools to file on a child’s behalf. In Washington, Mayor Vincent C. Gray asked the accounting firm Deloitte in February to suggest, among other things, ways to improve the system used by local schools to apply for reimbursements.

View the original article here