Medicaid Changes for Special Education May Be Costly

By Beverly A. Carroll, Chattanooga Times/Free Press, Tenn.

Oct. 23–A proposed change in Medicaid reimbursements for services for special education students could cost some local school districts thousands if they must cover the bill, area school administrators said.

A Georgia education spokeswoman said that overall, school districts in the Peach State stand to lose about $12.3 million in the next fiscal year.

“It is optional (to bill Medicaid),” said Georgia Department of Education spokeswoman Nancy O’Hara. But the “majority (of districts) in our state do choose to bill for some services. It’s cutting off a revenue stream that would have a local impact,” Ms. O’Hara said.

The proposal is among several changes included in the Centers for Medicare and Medicaid Services budget recently presented to the U.S. Department of Health and Human Services, which oversees federal and state health insurance programs.

It would end reimbursements for some administrative costs and for some travel-related costs for students receiving physical therapy and other medical services in school.

The change would address widespread problems, including improper billing for unprovided or ineligible services, according to the Government Accountability Office.

If approved, it will take effect next year and is projected to save the federal government more than $4 billion over five years.

Ione Carter, director of special education services for Cleveland, Tenn., City Schools, said, “We average around $3,500 to $4,000 a month savings by using vendors that bill Medicaid for occupational therapy and physical therapy. Medicaid offsets our costs. If this is lost, it will place the burden on (local budgets). We will have to fund it.”

Not many Tennessee school systems participate in the reimbursement program, according to Department of Education spokeswoman Katharine Mosher said.

However, Marilyn Wilson, spokeswoman for TennCare, which administers Tennessee Medicaid funds, said TennCare does not work with the Centers for Medicare and Medicaid Services to apply for funding for school-based health programs, such as the one that Cleveland City Schools provides.

“It’s a grant program, and your programs must be approved by the Centers for Medicare and Medicaid Services,” Ms. Wilson said. “We struggled through that approval process, and we also saw the writing on the wall years ago, particularly in some states where CMS was disallowing millions of dollars of expenditures.”

In some states, school districts were spending the money and then billing Medicaid assuming costs would be covered, Ms. Wilson said. When CMS refused to approve funding, those systems were responsible for the payment, she said.

Georgia school systems strive for inclusion, the blending of special education students with regular students, Georgia school officials said. Aids for students with hearing or vision problems go into the classroom with the students, said Elaine Womack, spokeswoman for Walker County Schools.

Spokesmen for several North Georgia schools said they do not anticipate any impact from the Medicaid rules changes.

“We do not (bill Medicaid) so it won’t have any impact on us,” Walker County special education director Penny Howerton said.

Richard Schoen, director of student achievement for Whitfield County Schools, also said he does not expect Whitfield County to lose any money if the rule changes.

Tim Callahan, spokesman for the Professional Association of Georgia Educators, said his association opposed the rule changes.

“We certainly want districts to be reimbursed as completely as possible,” Mr. Callahan said. “Special education students are costly to educate. The federal government originally promised to by 40 percent of the cost but they have never lived up to that. At 18 percent of the current costs, they are far short of that.”

E-mail Beverly A. Carroll at bcarroll@timesfreepress.com

ON THE WEB To see proposed Medicaid rule changes and post a comment, visit www.cms.hhs.gov/eRulemaking. Comments are due Nov. 6

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