New Resource for LEAs & Parents Regarding EOBs for School Health Services

DHCS has published a one-page informational that LEAs can share with parents regarding private insurance, explanation of benefits (EOB) statement for school health services, and impact to public benefits.

When a child has both Medi-Cal and Other Health Coverage (OHC) through private insurance, and a school is billing Medi-Cal for eligible health services provided to that student under the LEA Billing Option program, there is a possibility that the Department of Health Care Services will reach out to a child’s OHC to recoup funds paid by DHCS to the school district. This is commonly referred to as ‘pay and chase’.

Over the past year, as pay and chase efforts have increased, LEAs have encountered questions from parents around the process, what it means, and how it might impact their insurance benefits. These are the questions that DHCS touches on in the one-pager that LEAs can use to support their conversations with parents around the issue. Chief among these, are confirmations that:

  • parents will never be billed by DHCS or the school for services provided by the school to students; and,
  • participation in the LEA Billing Option program will not decrease public benefits, impact lifetime coverage, or increase Medi-Cal premiums.

Click here to read the DHCS letter, Medi-Cal and Private Health Insurance Information Regarding Explanation of Benefits (Oct. 23, 3017)…