The LEA Medi-Cal Billing Option is administered by the Department of Health Care Services (DHCS) and was established to:
- Support Healthy Start sites after their grant funding expires
- Develop Healthy Start collaboratives at sites without state grants
To clarify the intent of the LEA Medi-Cal Billing Option, the language used in the DHCS Provider Participation Agreement (PPA) that school districts are required to sign is taken directly from the Healthy Start Support Services for Children Act (Education Code, Section 8800). Thus, participating LEAs agree to convene Healthy Start collaboratives to set priorities for reinvesting Billing Option reimbursements in Healthy Start activities.
In January 1993, a State Partnership between the Governor, the State Superintendent of Public Instruction, and the Foundation Consortium established the LEA Medi-Cal Billing Option for School Linked Services. Reimbursements from the Billing Option must be used to supplement and not supplant existing state and federal funding.
The PPA states that LEAs must establish or designate an existing interagency human service group at the county level or subcounty level to make decisions about the reinvestment of LEA Medi-Cal funds. The DHCS LEA Medi-Cal Billing Option provides more information and the application. See the National Plan and Provider Enumeration System for information about the required National Provider Identifier number. Also see DHCS Medi-Cal for information on Medi-Cal services.
Collaboratives may vary according to community needs; however, representation should include schools, major public agencies serving children and families including health, mental health, social services, and juvenile justice, courts, civic and business leadership, the advocacy community, parents or guardians, and current safety net and traditional health care providers. We recommend that the LEA Medi-Cal Collaborative be composed of one-third school and district representatives, one-third youth and family members, and one-third community agency representatives. Scheduling meetings of the LEA collaborative two times per year is only a minimum. The process needs to promote full participation in policy development and decision-making.
The purpose of this interagency group or collaboration is to make collective decisions about planning, implementing, financing, and monitoring school-linked child and family support systems. It is also the responsibility of this collaborative to identify community needs, how to best meet those needs and to reinvest funds into schools or community organization to address those needs.
When school districts apply for Healthy Start Operational or Combined grants, they sign an agreement to sustain these services and programs after the grant period ends. Therefore, school districts applying for Healthy Start Operational grants must enroll in the LEA Medi-Cal Billing Option, because it is a mechanism for them to generate new funds to sustain and expand their Healthy Start sites.
Changes of physical service addresses or pay-to addresses, and general application inquires or application status should be submitted to the DHCS' Provider Enrollment Division by e-mail to PEDCorr@dhcs.ca.gov.