Medi-Cal Reimbursement and Compliance Programs

  • Students in Hallway

    About School Medi-Cal Programs

    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. School Medicaid programs are administered by the federal Centers for Medicare and Medicaid (CMS) and the California Department of Health Care Services (DHCS).

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

    The LAUSD Medi-Cal Reimbursement and Compliance office operates both programs and has the responsibility to recover costs from the federal government to offset the expenses of existing programs and to fund supplemental health and human services. 

    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 which includes direct assessment and services to Medi-Cal eligible students who are enrolled in Special Education and have an Individualized Education Plan (IEP) for certain services. Claims which capture this direct service are processed using the information entered by providers in the Welligent Service Tracking System (STS).

    Medi-Cal Administrative Activities (MAA)/Random Moment Time Survey (RMTS) Program

    The Medi-Cal Administrative Activities Program (MAA) claims reimbursement for the administrative activities require for the efficient operation of the Medi-Cal program in California. CMS requires school districts to conduct a quarterly time surveys for the calculation of the claims. LAUSD is the only school district in California approved by CMS to use a methodology called Random Moment Time Survey (RMTS). Approximately 3000 employees participate quarterly in the RMTS.