Review of Medicaid School Based Child Health Service Costs Claimed by Connecticut Department of Social Services October 1999 - September 2000

EXECUTIVE SUMMARY:

The Connecticut Department of Social Services (State agency) reimburses local educational agencies (LEAs) for Medicaid School Based Child Health (SBCH) services on the basis of statewide bundled rates.  However, our review of LEA documentation supporting random samples of SBCH claims paid to two LEAs disclosed that about 80 percent of the recipients received only about one-half of the total amount of SBCH treatment services recommended in their Individualized Education Plans (IEPs).  As a result, we have no assurance that all Federal Medicaid funds earmarked for SBCH services are being spent by LEAs on all recommended health related activities for Medicaid eligible children.  We found that the State agency has not developed any formalized procedures to coordinate the delivery of SBCH services with the State Department of Education (SDE) and LEAs to ensure that Medicaid eligible children are receiving services in accordance with their IEPs.  In addition, we believe that utilizing bundled rates for reimbursement of SBCH services can also create an incentive to reduce costs by limiting services provided to eligible recipients.  We recommended that the State agency coordinate the delivery of SBCH services to ensure that they are provided in accordance with all recommended services included in the IEPs, and establish procedures to periodically monitor the LEAs to ensure that Medicaid recipients are receiving all recommended services.

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