Medi-Cal Reimbursement Programs

Medi-Cal Reimbursement Programs

There are two complementary Medi-Cal reimbursement programs:
(for School Districts and County Offices of Education in California)

LEA Medi-Cal Billing Option

The Local Education Agency (LEA) Medi-Cal Billing Option program offers reimbursement for health and mental health evaluations, health education, treatments, Targeted Case Management (TCM) and limited medical transportation services, provided by eligible practitioners for eligible children and family members within the school environment.

Medi-Cal Administrative Activities (MAA)

One of Medicaid's established programs is the Medicaid Administration, which is referred to as the Medi-Cal Administrative Activities (MAA), in California.  Administered by the State Department of Health Services (DHS), this program reimburses LEAs for a portion of the costs incurred in administering Medi-Cal funded programs.

Approved Reimbursable Activities

Federally approved reimbursable activities include:

Providing Information

  • Outreach for available Medi-Cal sponsored programs (e.g., LEA billable services, Nursing, Adolescent Family Life Program (AFLP), Maternal Child Health (MCH), Children's Health & Disability Program (CHDP), California Children's Services (CCS), Mental Health, clinical/dental services)
  • Information on and referral to Medi-Cal eligibility offices and sites in the community providing Medi-Cal services

Assisting with Access

  • Assisting with the Medi-Cal enrollment process
  • Case coordination to provide referral to, and ensure effectiveness of, Medi-Cal covered services
  • Translation in order to enroll in or access health/Medi-Cal programs or services
  • Arranging transportation to Medi-Cal covered services

Planning for Health Programs

  • Analysis and planning of health and Medi-Cal services
  • Collaboration with others to fill gaps in health services

 
Please note - The one activity that overlaps both the LEA and MAA programs is Targeted Case Management (TCM).  This occurs because there are similarities in billable activities between TCM (through the LEA program) and the MAA program. As a result, individual participants billing for TCM are restricted in their participation in MAA.

**If you are billing for TCM through the LEA program, please be sure to claim only for the MAA activities that do not overlap with TCM.

For more information on the Medi-Cal Reimbursement program, contact JoAnn Cuadras at (760) 312-6428.