Final Judgment Issued in California Lawsuit Regarding Reimbursement for Free Care Services

On February 11, 2013, the San Francisco Superior Court (“the Court”) issued a final judgment in the lawsuit brought against the California Department of Health Care Services (DHCS) by the San Francisco Unified School District (SFUSD) regarding reimbursement for so-called free care services. The judgment was issued in favor of SFUSD and stipulates that the district is entitled to reimbursement for certain medical services provided to Medi-Cal eligible regular education students.

This judgment comes on the heels of a successful petition by DHCS to obtain federal financial participation (FFP) from the Centers for Medicare and Medicaid Services (CMS) for regular education claims submitted on behalf of SFUSD through the LEA Billing Option program. This means that many of the medically necessary health services provided to students in their district that are not linked to a special education plan may now be eligible for reimbursement.

It is important to note that the final judgment in this case is specific to SFUSD; however, because the Court determined that payment for health services provided to Medi-Cal eligible regular education students is available under California law (Welfare & Institutions Code Section 14132.06), we are hopeful that California will seize this opportunity and issue guidance allowing other school districts to begin seeking reimbursements for the same vital health services.

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Read the final judgment…

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