Audit of Medicaid School-Based Services in Oklahoma

This final report identified issues, which resulted in unallowable costs totaling at least $1,243,446 federal share.  Further, school districts did not obtain referrals for occupational therapy services or referrals for speech therapy services, which resulted in additional unallowable costs totaling at least $1,089,328 federal share.  We also could not reasonably determine whether school districts met the state share requirement, which totaled $2,801,658 due to the various errors identified with their calculations, inclusion of inappropriate expenditures, and use of inappropriate funding sources.  In addition, we identified the following areas of concern needing corrective action:  (1) the rates associated with school-based Medicaid services; (2) billing agency involvement in school districts' school-based Medicaid programs; and (3) the school-based health service providers' qualifications.  Recommendations call for financial adjustments and internal control improvements.