1. Community Driven School Health Planning Challenges and Outcomes in Colorado’s School-Based Medicaid Claiming Program

2. MESH Program Creation 1997 – Colorado Legislation CRS 26-4-531
Medicaid revenue would be used to expand preventive and primary health care services for public school children.

3. MESH Program Structure
Claiming (HCPF)
Bill Medicaid for medical services that are delivered to Medicaid clients in school setting
Local Services Plans (CDE)
Community-driven plan for delivery of health services to general student population
Generalized health services are funded by Medicaid reimbursement dollars
Second part is unique to Colorado
HCPF = Health Care Policy and Finance
CDE = Colorado Department of Education

4. Challenges Compliance with regulations
Revenue Generation vs. Revenue Spending
Lack of understanding
Lack of direction from CDE

5. MESH Funding Flow Regulating Authority CMS (Federal $) State (HCPF)
Federal Grant Contract
Federal Law
Medicaid Rules
Federal Medicaid Law
State Purchasing Contract
State Purchasing Law
Regulating
Authority
Program is administered through HCPF, not through CDE – it is not an education program
CMS is billed for services delivered to the client. This is subject to Medicaid rules and regulations.
CMS returns the Federal share of that service cost to the State in accordance with the State’s Medicaid Plan
Service to
Medicaid Client
(District $)
LSP Services
to all students
(District $)

6. Layers of Regulation Federal Medicaid Law CMS Guidelines
State Plan (CMS Contract)
State Purchasing Law
State Statute Authorizing Program
Department Rules
Program Guidelines
These all create challenges to the implementation of the program.
Conflicting intent of Federal and State statutes.

7. Conflicting Intents Federal Law State Law
To allow districts to recover some costs associated with unfunded IDEA mandates
State Law
No supplanting clause precludes districts from spending reimbursement funds on mandated services

8. Revenue Stream
Revenue generation – Federal level requirements (State Plan)
Revenue Spending – State level requirements

9. Spending Requirements
No supplanting - No spending on mandated services
Local Services Plans - Community driven health planning

10. Navigating the Complexities
Contradictory Requirements
Conflicting Systems
Coordination Between Departments
Lack of Definition
Delay of CMS Guidelines - audit exceptions interpreted as policy change
Medical vs. Health Service
Lack of Definition = district administration not understanding
- job duties not adequately identified (contract, fiduciary, legal, medical knowledge)
- responsibility level not understood

11. MESH Planning Steps (LSP)
Health Needs Assessment/Targeted Assessment
Gather Community Input
Organize Data
Make Decisions (prioritize needs)
Develop Program Plan
Gather information to assess the health needs of your community – notebook has some material to get you started
From community members with expertise or special information (health related)
From statistics, available health and demographic data – certain health problems associated with different cultural groups and settings
From other community members you feel would add to information
Uninsured/underinsured as special target population
Community Input is mandatory in decision-making process – Informed Participation
Present participants with results of Needs Assessment
Inform them of amount of reimbursement
Inform them of their role in the process – what you want their input for
Offer to send them the results of the process – final priorities
Organize the information from different sources – categorize, generate statistics – Ranking methodology
Prioritize health needs – determine process beforehand WHO? WHEN? HOW?
Write your goals based on the list of priorities you identified, write objectives based on these goals

12. Community Involvement
Community Based Organization
Community Center Board
Community Members
Group Home and Foster Care
Health Care Providers
Homeless Liaisons
Law Enforcement
Local Government
Mental Health Providers
Migrant Programs
Parents
Probation and Parole Officers
Public Health
Public Housing Programs
Refugee Programs
Religious Organizations
School Based Clinics
School Board
School District Staff
School-to Work Programs
Social Services, Students
Special Education Staff/ Providers
Teachers
Teen Parenting Programs
Transition Programs
Treatment Programs

13. Competing Priorities

14. MESH 2000-2001 Health Service Expenditures Health Service Category
# of Districts
Total
Expenditure
% 0f Total Expenditure
Assistance/Emergency Funds 6
$ ,954.60
0.84%
Assistive Technology 10
$ ,496.58
2.34%
Audiology 4
$ ,527.84
0.93%
Case Management
$ ,563.56
4.51%
Dental Services 1 $
0.01%
Health Assistant/Clinic Aide
$ ,207.89
7.80%
Health Education 3
$ ,843.51
0.67%
Health Tech 17
$ ,618.00
12.19%
Insurance Outreach - CHP+ & Medicaid 5
$ ,783.15
4.84%
Materials/Equipment/Supplies 32
$ ,682.00
8.16%
Mental Health 26
$ ,321.30
15.38%
Motor Therapy 2
$ ,040.41
1.14%
Nursing Services 40
$ ,673.16
23.94%
Nutrition
$ ,045.36
0.14%
Occupational Therapy 8
$ ,652.58
3.89%
Occupational/Physical Therapy[1]
$ ,030.00
0.33%
Orientation & Mobility
$ ,056.25
0.16%
Parent/Family Services
$ ,685.00
0.21%
Physical Therapy
$ ,584.30
1.59%
Professional Development 11
$ ,622.72
2.15%
Speech Language 15
$ ,996.30
6.85%
Transportation
$ ,123.00
Vision
$ ,606.40
0.80%
Nursing services is
[1] Some districts did not report Occupational and Physical Therapy as separate categories.

15. MESH 2000-2001 Expenditures by Service Type
Types of Service
MESH Expenditures by Service Type
Service Type
Expenditure
Direct Services
$2,938,076
Audiology, Case Management, Dental Services, Health Assistant/Clinic Aide, Health Tech, Mental Health, Motor Therapy, Nursing Services, Occupational Therapy, Orientation & Mobility, Physical Therapy, Speech Language, Vision
Other Services
$677,614
Assistance/Emergency Funds, Assistive Technology, Health Education, Insurance Outreach, Materials/Equipment/Supplies, Nutrition, Parent/Family Services
Indirect Services
$79,623
Professional Development

16. Contact Information
Barbara Ramsey
Colorado Department of Health Care Policy and Finance
1570 Grant St
Denver, Co 80203
Michelle Farrell
Colorado Department of Education
201 E Colfax Ave
Denver, CO 80203