Summary: Schools are an important service delivery and outreach point for Medicaid because one-third of those eligible for Medicaid are school-aged children. Even when schools do not directly provide Medicaid-covered health services, they can help identify, refer, screen, and assist in enrolling Medicaid-eligible children. Outreach and identification activities help ensure that the most vulnerable children receive routine preventive health care, primary care, and treatment. Most states are seeking Medicaid funds to help them provide medically related services to disabled children and direct children to appropriate health services. However, controls over the various approaches to submitting claims for Medicaid reimbursement for school-based health services and administrative activities are poor. Oversight by the Health Care Financing Administration has failed to ensure an appropriate balance between the states' demands for flexible, administratively simple systems and the need to account for whether federal funds being used as intended. The result is confusing and inconsistent guidance across the regions and failure to prevent improper practices and claims in some states. Without adequate controls and consistent oversight, Medicaid is vulnerable to paying for unneeded and undelivered services and activities. Weak agency oversight has created an environment ripe for opportunism and fraud.
