NAME regions

Iowa's LEA Medicaid Program is in its 10th Year & Continues to Grow

Jim Donoghue (IA)

The program here recognizes a broad range of IEP-ordered services, audiology, behavioral health paraprofessional, medical transportation, nursing, nutrition, occupational and physical therapies, personal health paraprofessional, school psychology, school social work, speech/language services, vision/orientation/mobility services and primary and preventive care services at school-based health centers. During the 2011-12 school year, Iowa began transition to 5010 registration and testing (Iowa LEAs can choose to self-bill through free software or use a vendor), and also increased its monitoring of the DHHS/OIG/DHHS Exclusions Database while weathering the first wave of Exclusions findings (so far, the state has found only two issues where an excluded individual provided billed services). Program Integrity audits by the Single State Medicaid Agency have resulted in reports of very limited instances of unsupported documentation and need for recoupment.

Iowa's program receives technical assistance from the Iowa Department of Education staff that meets with Iowa's Medicaid staff regularly to review audit compliance, policy, regulatory and training updates. For more information, contact Jim Donoghue, Iowa Department of Education (515) 281-8505 or visit

Michigan Updates -Kathy Merry (MI)

First, both Michigan and the NAME leadership board are sad about the recent departure of Scott DeVarona as our State Medicaid agency representative on the NAME board. Scott has been a real pleasure to work with in Michigan; he will definitely be missed. The NAME Nominating Committee is busy looking for a replacement and calls have gone out to the states in our Region to see if interested candidates exist. Don't hesitate to let us know if there is someone in your state Medicaid agency whom you believe would be a great addition to our NAME board.

Second, Kathy Merry is joining NAME President Jane Reagan in researching sites for the 2013 NAME Conference, which will be held here in beautiful Michigan. We are visiting hotels to find the best deals (also known as "best bang for the buck" for our members) and the best location for "out-of conference" fun events and experiences. We want to make Michigan shine by sharing what we believe is a GREAT state! Please stay tuned for further information as decisions are finalized at our website.

Ohio's Office for Healthcare Transformation (OHT) Continues to Develop New Ways for Medicaid to Better Serve the Most Vulnerable Ohio Students - Mark Smith, OH

Two recent developments place an emphasis on increasing access to Medicaid primary care services. Firstly, Ohio is poised to begin development of a separate Medicaid provider status for School-Based Healthcare Centers (SBHCs). These centers will be able to bill Medicaid directly for primary care services by providing them in a clinic setting on school grounds. This effort should also allow SBHCs to become part of Medicaid Managed Care Organizations' (MCOs) provider panels. Along with the state's recent decision to place all Medicaid-eligible children with intensive needs into MCOs, it will provide MCOs with an enhanced capitation payment if they improve performance outcomes related to adolescent services. For more information on Ohio's School-Based Healthcare Programs, please visit:

Secondly, Ohio has begun the process of developing protocols for Medicaid presumptive eligibility for program enrollment and is exploring ways to enroll an estimated 70,000 children who are eligible for Medicaid services, but have not been through the enrollment process. The possibilities being explored would allow Ohio's Medicaid program to "presume" Medicaid eligibility based on the review of existing data that indicates probability of a student's eligibility for services, such as eligibility for the Free and Reduced Lunch Program. This effort is exciting not only in enrolling children who are lacking adequate medical care, but also in opening new doors of sharing data across the educational threshold with other health and human services organizations for the betterment of the whole child. For more information on Ohio's Medicaid program, please visit:

For an Illinois update see the "In The Media" article - Chicago Tribune