Why is October 5th such an important date in the MA School-Based Medicaid calendar?
Along with July 5th, January 5th and April 5th, school districts who participate in the School-Based Medicaid program must determine the Medicaid eligibility of both their entire student body as well as their special education students. The state requires these 4 times per year to determine who is actually enrolled in the districts on these dates.
As of each date, districts should use their student information systems (i.e. PowerSchool, Infinite Campus, eSped, Adori, etc.) to run both lists and include the first name, last name, date of birth and gender. Districts then directly, or with the assistance of their Medicaid vendor (UMass, MSB, etc.) compare these lists electronically with the Health and Human Services electronic database of eligible members to determine their district’s percentages of Medicaid eligibility.
This is very important to do because:
- It’s required of all districts who participate in the Medicaid program
- These figure provide statistics that are used to determine rates of reimbursement to participating school districts, and have a significant impact as to how much Medicaid reimbursement a district receives
If a district were to be audited by either MA Executive Office of Health and Human Services or by the federal Centers for Medicare and Medicaid Services, it is probable that the district would be asked to produce the lists they run each 5th of the quarter, and demonstrate their process for matching eligibility with the state database. The Provider Contract between the districts and MA Health and Human Services requires districts to maintain these records for at least six years for purposes of audit.
Should you have questions or would like more in depth information about this topic or School-Based Medicaid in general, please do not hesitate to give us a call, 800-618-3111.