LEA Program Overview
The LEA Medi-Cal Billing Option Program was established in 1993, in collaboration with the California Department of Education (CDE), to fund Healthy Start Programs. It is authorized under California’s Welfare and Institutions Code section 14132.06, and reimbursement is based upon a “fee-for-service” model.
The LEA Medi-Cal Billing Option Program provides reimbursement to LEAs (school districts, county offices of education, charter schools, community colleges, and university campuses) for health-related services provided by qualified medical practitioners to Medi-Cal eligible students under the age of 22. Eligible services include:
Health and Mental Health Evaluation and Education Assessments
Psychology and Counseling
School Health Aide Services
Targeted Case Management
To allow LEAs to become Medi-Cal providers and bill the Medi-Cal program for certain health related assessments and services provided to beneficiaries by qualified medical professionals.
Medi-Cal eligible individuals under
the age of 22
attending Public School (K-12), Charter
Schools, Community Colleges, and
Who Provides Services
The services are delivered through the LEAs. The LEAs either employ practitioners who provide the services on site, or use practitioners under contract with the LEA.
The LEA Medi-Cal Billing Option Program is funded with a combination of local and federal Title XIX (Medicaid) funds. Claims are filed using the traditional Medi-Cal fee-for-service system through the Department of Health Care Services (DHCS) fiscal intermediary. LEAs pay for the services and are reimbursed the federal funds, at 50% of cost, for each individual service; therefore, there is no State General Fund expense for this program.
LEAs must annually certify that the public funds expended for LEA services provided are eligible for federal funds pursuant to Code of Federal Regulations, Title 42, Section 433.51. DHCS must reconcile the interim Medi-Cal reimbursements to LEAs with the costs to provide the
Medi-Cal services. The Cost and Reimbursement Comparison Schedule is used to compare each LEA’s total actual costs for LEA services to interim Medi-Cal reimbursement for the preceding fiscal year.
The LEA Advisory Workgroup meets bi-monthly and is comprised of large, medium and small LEAs, Local Governmental Agencies (LGAs), Local Educational Consortia (LECs), DHCS, CDE, and professional associations with the purpose to enhance Medi-Cal services on school sites, increase access of care for students, and increase Medi-Cal reimbursement for LEAs.