001Jessica Vaughn: OUR MEDICAID UPDATE WORKSHOP IS NOW CALLED TO ORDER. I'LL TURN THIS OVER TO SUPERINTENDENT AYRES. Van Ayres: THANK YOU, MADAM CHAIR. BOARD MEMBERS THIS MORNING, THIS IS A WORKSHOP THAT WAS REQUESTED BY THE BOARD. AND THIS IS A MEDICAID UPDATE. THIS WILL BE DONE THROUGH OUR FINANCE OFFICE. AGAIN, THIS IS A REQUESTED WORKSHOP BY OUR BOARD ON UPDATES AROUND MEDICAID. SO WHAT THIS WORKSHOP WILL LOOK LIKE IS WE'LL SPEND THE FIRST 15, 20 MINUTES JUST KIND OF PROVIDING AN OVERVIEW OF MEDICAID. AFTER THAT, WE'LL MOVE INTO SOME DISCUSSION AROUND THAT. OF COURSE, LIKE ALL OF OUR WORKSHOPS, TO PROVIDE SOME DIRECTION AROUND THIS TO MYSELF AND MR. LEWIS, OUR CHIEF FINANCIAL OFFICER. I'LL TURN THIS OVER AT THIS POINT TO MR. LEWIS, OUR CFO, WHO WILL INTRODUCE HIS TEAM. Jamie Lewis: THANK YOU,
002BOARD MEMBERS, AND SUPERINTENDENT AYRES, FOR THE OPPORTUNITY FOR FINANCE TO COME TALK TO YOU GUYS ABOUT WHAT IS OUR MEDICAID PROGRAM. WE'RE GOING TO TAKE THIS NEXT FEW MINUTES TO INTRODUCE WHAT MEDICAID IS HERE AT OUR DISTRICT, WHICH IS A LITTLE BIT DIFFERENT THAN MAYBE WHAT YOU THINK AND THE MULTIPLE PROGRAMS THAT WE HAVE. AND THEN TALK ABOUT SOME CHALLENGES AND SOME OPPORTUNITIES THAT WE HAVE WITH IT. I HAVE A LOT OF MY STAFF HERE THAT CAN ANSWER QUESTIONS LATER ON. BUT I DO WANT TO INTRODUCE OUR -- WHAT I'M CALLING OUR MEDICAID EXPERT, MS. GRACIANI. SHE WILL HELP US WALKING THROUGH THE PRESENTATION AND THEN WE'LL WELCOME QUESTIONS AT THE END. GOOD MORNING, EVERYONE. I APPRECIATE THIS OPPORTUNITY. I'M EXTREMELY HAPPY TO BE ABLE TO PRESENT TO YOU AND TELL YOU ABOUT OUR MEDICAID
003PROGRAM. MY EXPERIENCE I THINK IS IMPORTANT BECAUSE I WORKED FOR BROWARD COUNTY SCHOOLS FOR ABOUT 28 YEARS BEFORE I CAME TO HILLSBOROUGH THREE YEARS AGO. SO WHILE WE WERE IN BROWARD THE LAST 20 YEARS, I WORKED WITH THE SCHOOL-BASED MEDICAID. SO I'VE BEEN IN THIS INDUSTRY FOR MANY, MANY YEARS. SO NOW I'M AT HILLSBOROUGH. AND WE WANT TO PRESENT TO YOU AND LET YOU KNOW ABOUT WHAT'S GOING ON WITH THE BIGGER PICTURE OF MEDICAID, WHAT MEDICAID IS. WE WANT TO TELL YOU ABOUT THE MEDICAID PROGRAM ITSELF THAT WE HAVE WITHIN BROWARD -- EXCUSE ME, HILLSBOROUGH SCHOOLS. AND ALSO THE POLICY CHANGES THAT ARE GOING TO IMPACT US AS WELL AS WHAT ARE OUR NEXT STEPS? WHAT ARE WE GOING TO DO TO MAKE THIS PROGRAM SUCCESSFUL? ALSO, WHAT TYPE OF SUPPORT THAT WE NEED FROM
004THE BOARD. WHAT IS MEDICAID? IT IS A LOW-COST OR FREE HEALTH INSURANCE FOR FAMILIES AND CHILDREN. IT COVERS ALL MEDICALLY NECESSARY SERVICES, ALMOST 40% OF THE USE A STUDENTS, U.S. POPULATION ARE COVERED BY EITHER MEDICAID OR CHIP, WHICH IS CHILDREN HEALTH INSURANCE PROGRAM. MEDICAID IS THE FOURTH LARGEST FUNDING STREAM FOR SCHOOLS. EVERYONE CAN HEAR ME OKAY? OKAY. ALSO, MEDICAID SUPPORTS ABOUT $7.5 BILLION AS MONEY FOR SCHOOL-BASED SERVICES FOR THE SCHOOL DISTRICTS ACROSS THE UNITED STATES. WHAT IS MEDICAID? SO WE HAVE MEDICAID IN SCHOOLS NOW. SO MEDICAID IN SCHOOLS, ACCORDING TO THE CENTERS FOR MEDICARE OR MEDICAID, THAT'S CMS. ACCORDING TO CMS, SCHOOL DISTRICTS HAVE A UNIQUE OPPORTUNITY TO BE ABLE TO ACCESS STUDENTS. SO THIS IS THE BEST PLACE FOR US TO HAVE THESE MEDICAID PROGRAMS. WE'RE ABLE TO ENROLL OUR STUDENTS IN MEDICAID. WE'RE
005ABLE TO PROVIDE SERVICES FOR THEM. AND WE'RE ABLE TO HAVE THEM -- GIVE THEM ACCESS TO THOSE SERVICES. SO CONGRESS APPROVED THIS AND ALSO THEN THE FLORIDA LEGISLATURE ALSO ENACTED SOME RULES AROUND IT. SO WE HAVE TWO MEDICAID PROGRAMS HERE IN HILLSBOROUGH COUNTY SCHOOLS. SO THOSE TWO MEDICAID PROGRAMS ARE THE MEDICAID CERTIFIED SCHOOL MATCH PROGRAM. SO THAT IS THE PROGRAM WHERE IF I'M A SPEECH PATHOLOGIST AND I SEE JOHNNY FOR 30 MINUTES, I PROVIDE JOHNNY HIS SPEECH THERAPY. I DOCUMENT THOSE SERVICES, AND THEN OUR DEPARTMENT TAKES OVER AND SUBMITS THOSE SERVICES. SO THAT'S ONE PROGRAM THAT EVERYBODY IS PRETTY FAMILIAR WITH. THE OTHER PROGRAM THAT WE RUN HERE IN HILLSBOROUGH COUNTY IS A TIME SAMPLE. SO WHAT WE DO -- AM I ON THE WRONG SLIDE? THE MEDICAID SCHOOL DISTRICT, WE HAVE THE ESTACK PROGRAM.
006WE FOCUS ON OUTREACH TO STUDENTS AND HELP THEM GET THEIR SCHOOL-BASED HEALTH SERVICES. IT'S A SHARED PARTNERSHIP, THIS MEDICAID PROGRAM IS A SHARED PARTNERSHIP BETWEEN THE FEDERAL AND STATE GOVERNMENT. AND HOW -- WHAT DOES THAT PARTNERSHIP LOOK LIKE? WE HAVE A STATE PLAN. SO THE STATE PLAN DETAILS EVERYTHING THAT WE'RE ALLOWED TO DO. SO WITH THAT STATE PLAN, IF YOU EVER WANT TO MAKE CHANGES TO THAT, AND WHEN I SAY YOU, I MEAN THE STATE OF FLORIDA. IF THEY EVER WANT TO CHANGE THAT STATE PLAN, THEN THEY HAVE TO DO A SUBMIT A SPA. IT'S A STATE PLAN AMENDMENT. CURRENTLY, IT TAKES 15 TO 18 MONTHS TO GET A SPA APPROVED. THAT'S IMPORTANT THAT YOU'LL HEAR LATER IN THE PRESENTATION ABOUT THE SPA. WHERE DO WE START? WE START WITH ENROLLING STUDENTS IN MEDICAID. HOW
007DO WE DO THAT AS A SCHOOL DISTRICT? SO THE SCHOOL DISTRICT HAS A MEMORANDUM OF AGREEMENT WITH THE FAMILY HEALTH CARE FOUNDATION, AND WE'VE HAD THAT AGREEMENT FOR AT LEAST THE LAST TEN YEARS THAT I CAN TELL. SO WE WORK WITH THE HAPPILY HEALTH CARE FOUNDATION TO -- WORK WITH THE FAMILY HEALTH CARE FOUNDATION TO GET THE STUDENTS ENROLLED AND WE ALSO WORK WITH OTHER DEPARTMENTS WITHIN THE SCHOOL DISTRICT. WE ARE WORKING WITH FACE FOR THE COMMUNITY, WE'RE WORKING WITH THE ESE DEPARTMENT. WE'RE WORKING WITH THE FINANCE STUDENT SERVICES. SO THIS ISN'T JUST A ONE-DEPARTMENT PROGRAM. IT INTERFACES WITH MANY, MANY, MANY OTHER DEPARTMENTS WITHIN THE SCHOOL DISTRICT. WE HAVE THIS MEMORANDUM OF AGREEMENT WITH THE FAMILY HEALTH CARE FOUNDATION. WHAT DO THEY PROVIDE FOR US? WELL, THEY HAVE ALL THE KNOWLEDGE. THEY KNOW HOW
008TO ENROLL STUDENTS IN MEDICAID. THEY ARE ABLE TO EDUCATE AND EDUCATE OUR PARENTS AND OUR FAMILIES. THEY HAVE TOOL KITS AND MEDIA TOOL KITS TO BE ABLE TO BRING OUT TO THE SCHOOLS. THEY GO TO OUR OPEN HOUSES. THEY HAVE BAY CARE NAVIGATORS WHICH ARE MOBILE MEDICAL BUS. SO THEY ARE ABLE TO GO TO ALL THE SEVEN SITES FOR THE CHILDREN'S BOARD AND ENROLL THESE STUDENTS. THEY SCREEN THEM AND THEN THEY ENROLL THEM. IF THEY DON'T ENROLL THEM IN MEDICAID OR CHIP, CHILDREN'S HEALTH INSURANCE PROGRAM, THEN THEY'LL FIND A LOW-COST HEALTH INSURANCE THAT THEY CAN AFFORD THAT WILL MEET THE FAMILIES' NEEDS. SO WE PARTNER WITH THEM AS WELL AS OTHER DEPARTMENTS WITHIN THE SCHOOL DISTRICT. WHAT ARE THE ELIGIBILITY REQUIREMENTS FOR STUDENTS? SO THEY HAVE TO BE A U.S. CITIZEN, QUALIFIED IMMIGRATION STATUS. YOUR
009INCOME, THEY LOOK AT HOW MUCH MONEY YOU MAKE OR DON'T MAKE. IF YOU ARE A PREGNANT WOMAN, THEY PAY FOR THE SERVICES IF YOU QUALIFY OF HAVING THAT BABY. ALSO, WE HAVE FAMILIES THAT HAVE A LOT OF HIGH MEDICAL EXPENSES, AND THEY CAN APPLY FOR A MEDICAID WAIVER. SO THOSE ARE THE QUALIFICATIONS TO BECOME MEDICAID ELIGIBLE. AND WE'LL GO A LITTLE MORE INTO THAT IN A BIT. BUT IN HILLSBOROUGH COUNTY SCHOOLS, I ESTIMATE THAT WE HAVE ABOUT 8,000 MEDICAID ELIGIBLE STUDENTS RECEIVING SERVICES. SO WE CAN HAVE MEDICAID ELIGIBLE STUDENTS IN THE DISTRICT BUT AREN'T RECEIVING SERVICES, SO THERE'S NO REIMBURSEMENT. THAT'S WHERE THE 8,000 NUMBER COMES FROM, BECAUSE THEY ARE RECEIVING. AND THAT'S ESE ONLY AT THIS POINT. SO IMMIGRATION STATUS, I'LL GO OVER THIS REAL QUICK. IT IS THE QUALIFIED IMMIGRATION STATUS YOU HAVE
010TO HAVE. I THOUGHT IT WAS IMPORTANT FOR YOU TO KNOW THAT WE ALSO HAVE PROGRAMS FOR CHILDREN UNDER 19 FOR EMERGENCY MEDICAL SERVICES. AND THE CHILDREN, REGARDLESS OF THE IMMIGRATION STATUS, MAY BE ELIGIBLE FOR CHIP UNDER THE AFFORDABLE CARE ACT WHICH PROVIDES SERVICES TO COMPREHENSIVE HEALTH CARE SERVICES. WE'LL TAKE A LOOK AT THE INCOME LIMITS TO SHOCK YOU A BIT. THE FIRST SLIDE TELLS YOU ABOUT AGE GROUPS. I'LL GO TO THE SECOND SLIDE TO SAVE TIME AND LOOK AT THE ANNUAL INCOME GUIDELINES. IF YOU LOOK AT A FAMILY OF FOUR, THEY CAN'T MAKE MORE THAN $42,760. THEY MAKE $42,761, THEY ARE NO LONGER ON MEDICAID. MAYBE THEY CAN GET CHIP, BUT THEY DON'T QUALIFY FOR MEDICAID. THERE ARE OTHER REQUIREMENTS AS WELL. IT'S NOT STRICTLY INCOME. SO THAT WAS JUST SO YOU HAD A LITTLE
011BIT OF INFORMATION ON THAT. WHY ARE WE UNIQUE? WHY IS THE SCHOOL-BASED MEDICAID PROGRAM DIFFERENT FROM THE COMMUNITY PROVIDER? WELL, THERE'S AT LEAST TWO REASONS. ONE OF THEM IS THAT WE GET PAID DIFFERENTLY? WE GET REIMBURSED DIFFERENTLY THAN SAY A HOSPITAL OR A DOCTOR'S OFFICE. WE GET REIMBURSED THROUGH TIME SAMPLES. WE ASK, WHAT ACTIVITY WERE YOU ENGAGED IN AT A SPECIFIC MOMENT IN TIME? FOR EXAMPLE, ON APRIL 11 AT 2:11 P.M., WHAT WERE YOU DOING AT THAT MOMENT? THAT CAN BRING IN A SIGNIFICANT AMOUNT OF REIMBURSEMENT TO THE DISTRICT. AND THEN THE SECOND PROGRAM IS DIRECT SERVICES. SO IT'S THE SAME THING YOU'RE USED TO SEEING. I'M A SPEECH PATHOLOGIST. I SEE JOHNNY FOR 30 MINUTES. I DOCUMENT IT. HE'S MEDICAID ELIGIBLE. I HAVE PARENTAL CONSENT AND SOME OTHER COMPLIANCE CHECKS WE HAVE TO DO,
012AND WE SUBMIT IT AND CAN GET REIMBURSED FOR THAT. TWO PROGRAMS IN THE HILLSBOROUGH COUNTY SCHOOL DISTRICT. THEN THE SECOND OTHER DIFFERENCE IS CONSENT. WE NEED PARENTAL CONSENT TO BE ABLE TO BILL FOR THOSE SERVICES AND ALSO TO RELEASE INFORMATION TO THE ENTITY, THE MEDICAID ENTITY. LET'S GET INTO DETAILS. SCHOOL DISTRICT ADMINISTRATIVE CLAIMING, THAT'S PROGRAM NUMBER ONE. LIKE I SAID WE RUN TWO MEDICAID PROGRAMS. THE FIRST PROGRAM IS THE ESTAC, SCHOOL DISTRICT ADMINISTRATIVE CLAIMING OR RANDOM MOMENT TIME SAMPLE. RMS OR RMTS. IT'S A MOMENT. RANDOM IN TIME, 2:10 P.M. WHAT DO WE GET REIMBURSED FOR? WE GET REIMBURSED FOR SEEKING OUT, IDENTIFYING, REFERRING, MONITORING, TRAINING, AND LEARNING. SO THESE ARE THE THINGS, THE ACTIVITIES THAT WE'RE TRYING TO CAPTURE FROM OUR STAFF MEMBERS OF WHAT YOU WERE DOING AT YOUR MOMENT IN TIME. IF YOU
013ARE DOING ONE OF THESE ACTIVITIES ON THE SHEET, THEN WE CAN GET REIMBURSED FOR THOSE ACTIVITIES. LET'S DIG A LITTLE BIT DEEPER INTO THE PROGRAM. WHAT HAPPENS? WE HAVE FOUR QUARTERS, AND WE SAMPLE OUR PARTICIPANTS, MEANING WE SURVEY THEM, EVERY QUARTER. HOW MANY PEOPLE? THERE'S ABOUT A POOL OF BETWEEN 3,000 TO 3500 DEPENDING ON THE QUARTER ARE IN THE SAMPLE POOL. OUT OF THOSE PEOPLE EVERY QUARTER, WE SELECT ABOUT 80 TO 90 DEPENDING ON STATS. WE PARTICIPATE IN THE DOE PROGRAM SO THEY REALLY DO MOST OF THAT PART OF IT. IT'S ABOUT 80 TO 90 SURVEYS THAT WE DO EVERY SINGLE QUARTER. AND WE ASK THE STAFF THREE QUESTIONS. ARE YOU READY FOR THIS? WHO ARE YOU WITH? WHAT ARE YOU DOING? AND WHY ARE YOU DOING IT? THREE QUESTIONS. A SIGNIFICANT AMOUNT OF MONEY.
014SO STAFF MEMBERS ARE NOT TOLD THE DATE AND THE TIME OF THEIR TIME SAMPLE UNTIL THE DAY THEY ARE SAMPLED. THAT WILL CHANGE IN 2026. YOU'LL HEAR ME TALK ABOUT THAT IN A MINUTE. THAT WILL CHANGE TO, THEY'LL GET TWO DAYS' NOTICE. SO WE CAN TELL THEM TWO DAYS IN ADVANCE THAT YOUR MOMENT IS GOING TO BE APRIL THE 5th AT 2 P.M. RIGHT NOW, THEY GET A NOTIFICATION AT 4 A.M. IN THEIR E-MAIL, AND WE ASK THEM SEVEN DAYS IN ADVANCE TO LOOK AT YOUR E-MAIL EVERY MORNING AND WAIT FOR THAT MOMENT. THEN THEY'LL KNOW WHEN THEIR MOMENT IS. THEY'LL GET THE E-MAIL THAT SAYS YOUR MOMENT IS TODAY, IT'S AT 2:00, AND IT WILL GIVE THEM THE INSTRUCTIONS ON WHAT THEY HAVE TO DO. SO THE STAFF MEMBERS THAT PARTICIPATE IN THIS PROGRAM,
015THEY CANNOT BE 100% FEDERALLY FUNDED. AND THEN ONCE THEY REPLY TO THE SURVEYS, THE MEDICAID TEAM CODES THE SURVEYS BASED ON THE GUIDE THAT WE HAVE AND BASED ON THE CODES WE GET REIMBURSED. AND THE CURRENT PARTICIPATION RATE WE HAVE TO GET BACK 75%, ALTHOUGH OUR GOAL IS 95 TO 100, WE ALWAYS WANT EVERY SINGLE ONE BACK, BUT IN 2026, THEY WILL BE CHANGING THAT TO 85% PARTICIPATION. AND ALSO THEY HAVE TO RETURN THEIR FORMS IN TWO DAYS, TODAY IT'S SEVEN DAYS. IT WILL BE A BIGGER CHALLENGE COME 2026 TO GET THOSE TIME SAMPLES BACK. SO WHO ARE WE SAMPLING? WHO PARTICIPATES IN THESE PROGRAMS? ON THE RIGHT SIDE -- ON THE LEFT SIDE OF THE SCREEN, YOU SEE YOUR DIRECT SERVICE PROVIDERS AND ON THE RIGHT SIDE YOU SEE LIKE ESE TEACHERS, ESE SPECIALISTS,
016PRINCIPALS, THIS WHOLE GROUP IS INCLUDED IN THE TIME SAMPLE. IT'S ABOUT 3,000 TO 3500 STAFF MEMBERS EVERY QUARTER, WHOEVER IS IN THOSE ROLES FOR THAT QUARTER. SO THAT WAS THE SDAC PROGRAM. THAT WAS PROGRAM NUMBER 1. IT IS A TIME SAMPLE. THREE QUESTIONS. WE CODE IT. WE GET REIMBURSED. WISH IT WAS THAT SIMPLE. SCHOOL MEDICAID PROGRAM NUMBER TWO. SO THIS PROGRAM IS A FEE FOR SERVICE PROGRAM. MANY OF YOU HAVE HEARD THAT TERMINOLOGY, FEE FOR SERVICE. WE PROVIDE A SERVICE. WE CHARGE A FEE. SO WHAT ARE THE REQUIREMENTS OF THIS PROGRAM? SO WE HAVE TO HAVE PARENTAL CONSENT. THERE HAS TO BE SOME TYPE OF A PLAN. A TREATMENT PLAN, IEP PLAN, A HEALTH CARE PLAN, POSITIVE BEHAVIOR INTERVENTION PLAN. THERE HAS TO BE A PLAN FOR US TO GET REIMBURSED BECAUSE, OF COURSE, MEDICAID,
017THE NEXT REQUIREMENT IS THEY WANT DOCUMENTATION. SO WE HAVE TO HAVE THOSE THINGS AS A BACKUP FOR DOCUMENTATION. WE ALSO HAVE TO HAVE APPROVED PROVIDER. SO OUR SPEECH PATHOLOGIST, THEY HAVE TO HAVE CERTAIN CREDENTIALS, PSYCHOLOGIST, THEY HAVE TO HAVE CERTAIN CREDENTIALS IN ORDER TO PARTICIPATE IN THESE PROGRAMS. ANOTHER PART OF THIS FEE FOR SERVICE PROGRAM IS THE DIRECT SERVICES TO STUDENTS, RIGHT? SO WHAT ARE THOSE CATEGORIES THAT WE GET REIMBURSED FOR DIRECT SERVICES? WE GET REIMBURSED FOR MENTAL HEALTH SERVICES. THERE ARE SERVICES WE PROVIDE FOR COUNSELING ARE ALL THE EVALUATIONS THAT WE DO. WE GET REIMBURSED FOR NURSING SERVICES, MEDICATION SERVICES, THERAPIES WE GET REIMBURSED FOR SPEECH LANGUAGE, OTPT, AND ALSO, BELIEVE IT OR NOT, WE GET REIMBURSED FOR TRANSPORTING STUDENTS TO SCHOOL AND HOME FROM SCHOOL. NOBODY THINKS MEDICAID HAS ANYTHING TO DO WITH
018TRANSPORTATION IN THE SCHOOL DISTRICT, BUT WE DO. AND OUR TRANSPORTATION DEPARTMENT IS DOING A PHENOMENAL JOB CAPTURING THOSE RIDES ON THE BUS. SO WE TRANSPORT A STUDENT TO SCHOOL AND THEY HAVE A SERVICE THAT DAY, THE NURSING SERVICE, AND WE TRANSPORTED THEM HOME, WE GET TO BILL THEM FOR TWO SERVICES, FOR THE RIDE HOME AND THE RIDE TO SCHOOL. SO IT'S IMPORTANT THAT THOSE SERVICES ARE IN THE SYSTEM AND DOCUMENTED BECAUSE WE NOT ONLY LOSE THE SERVICE, BUT WE WOULD LOSE THE TRANSPORTATION REIMBURSEMENT AS WELL. WHICH STAFF MEMBERS PARTICIPATE IN THIS PROGRAM? SO YOU'LL SEE IT WAS JUST THAT ONE SLIDE, BUT THESE ARE THE PEOPLE THAT HAVE A DOE CERTIFICATION OR A LICENSE. AND IT ALSO INCLUDES CONTRACTED STAFF. I WANT TO MENTION THAT, BECAUSE WE HAVE QUITE A FEW SPEECH LANGUAGE PATHOLOGISTS THAT
019ARE CONTRACTED. HOWEVER, THEY ARE REQUIRED TO DO THE SAME THING AS OUR SCHOOL DISTRICT EMPLOYEES REGARDING THE MEDICAID PROGRAM. SO OUR FEE FOR SERVICE RATE SCHEDULE. SO WHAT DO WE GET REIMBURSED? HOW MUCH IS IT? THE STATE MEDICAID AGENCY REIMBURSES SCHOOL DISTRICT BASED ON A FEE SCHEDULE. THESE ARE RATES FROM LIKE 1997 OUT OF THE 2005 MEDICAID HANDBOOK. AND THE FEE SCHEDULE LISTS TYPES OF SERVICES. FOR EXAMPLE, WE CAN GET REIMBURSED A FEE FOR PSYCH EVALUATION THAT WE DO FOR OUR STUDENTS. SO THAT'S HOW WE GET REIMBURSED BASED ON THE FEE SCHEDULE FOR THIS PROGRAM. SO THE NEXT SLIDE IS CERTIFICATION OF PUBLIC EXPENDITURES. I'M GOING TO READ IT TO YOU, BUT THIS IS REALLY IMPORTANT THAT YOU UNDERSTAND THIS BECAUSE THIS HAS BEEN A CHALLENGE FOR US, AND THIS IS WHERE WE ARE OUT
020OF COMPLIANCE. SO WHAT IS THE CERTIFICATION OF PUBLIC EXPENDITURES? EVERY TIME I SUBMIT A CLAIM, WE HAVE TO SIGN THIS FORM. AND WHAT DOES THE FORM SAY? IT SAYS THE SCHOOL DISTRICT HAS EXPENDED THE STATE SHARE OF PUBLIC, NONFEDERAL FUNDS NEEDED TO MATCH THE FEDERAL SHARE OF MEDICAL CLAIMS BILLED TO THE STATE MEDICAID AGENCY FOR SCHOOL DISTRICT SERVICES PROVIDED TO AND ON BEHALF OF ELIGIBLE MEDICAID STUDENTS WITH EACH QUARTER'S CLAIM. WHAT DOES THAT MEAN? BASICALLY IT MEANS WE GET REIMBURSED FOR WHAT OUR COSTS ARE. IF IT COSTS US $10 TO TRANSPORT ONE ESE KID TO SCHOOL, THAT'S OUR COST AND HOW WE SHOULD BE REIMBURSED, NOT ON A FEE SCHEDULE. THIS HAS BEEN -- WELL, LET'S GO TO THE NEXT SLIDE. WE HAVE BEEN OUT OF COMPLIANCE ALONG WITH THESE OTHER STATES AS WELL. WE
021DID SOME RESEARCH, AND IN 2022, THE HEALTHY SCHOOLS PROMISING FUTURES WHO IS A PARTNER OF OURS, WHO REALLY ADVOCATES FOR SCHOOL-BASED HEALTH SERVICES, THEY DID A SURVEY, AND THERE'S FIVE DISTRICTS. OR STATES AND FLORIDA IS STILL OUT OF COMPLIANCE. IN 2014 IS WHEN WE WENT OUT OF COMPLIANCE. SINCE THEN, WE HAVE NOT BEEN PAID THE WAY THAT WE SHOULD BE BEING REIMBURSED. SO HERE'S SOME RECENT EVENTS. GIVES YOU SOME DATES, HOW WE GOT TO THIS PLACE WHERE WE ARE THAT WE ARE OUT OF COMPLIANCE. AND IT'S UNDER THE CODE OF FEDERAL -- CODE OF FEDERAL REGULATIONS. WHAT DOES IT SAY? WHY ARE WE OUT OF COMPLIANCE? BECAUSE WE RECEIVED A LETTER IN 2020 FROM THE FEDERAL GOVERNMENT TO THE STATE GOVERNMENT SAYING THE SCHOOL DISTRICTS MAY NOT BE PAID FROM A FEE SCHEDULE AND USE
022THIS AS A CERTIFICATION OF COSTS. SO THAT WAS THE CPE. PER BETH KIDDER, DEPUTY SECRETARY FOR MEDICAID IN 2020. NOW, WE HAVE SOME TALKING POINTS IN THE BACK THAT WE DIDN'T WANT TO TAKE THE TIME TO GO OVER ALL OF THAT BUT WE DID CREATE A ONE-PAGER FOR YOU AS A RESOURCE TO UNDERSTAND A LITTLE BIT MORE IN-DEPTH OF WHAT IS HAPPENING. SO IN 2019, AHCA, THE AGENCY FOR HEALTH CARE ADMINISTRATION, WHO IS OUR STATE MEDICAID AGENCY, THEY SUBMITTED A SPA, AND CMS APPROVED THE SPA TO ADD NON-ESE STUDENTS. WE'RE NOW ABLE SINCE 2020 TO BE ABLE TO CAPTURE SERVICES THAT WE PROVIDE TO STUDENTS THAT ARE GEN ED THAT ARE MEDICAID ELIGIBLE THAT ARE RECEIVING SERVICES. SO THAT'S BEEN SINCE 2020. I CAN TELL YOU THAT FLORIDA IS WAY BEHIND IN ALL THE OTHER
023SCHOOL DISTRICTS IN CREATING THIS INFRASTRUCTURE TO BE ABLE TO DOCUMENT AND GET REIMBURSED FOR THAT. IN 2019, WE SUBMITTED THE SPA, THE STATE DID FOR NON-IEP SERVICES AND ALSO TO INCLUDE CHARTER SCHOOLS AND PRIVATE SCHOOLS IN MEDICAID -- IN THE MEDICAID PROGRAMS. IN 2020, THE GOVERNOR SIGNED IT INTO LAW, AND THEN ALSO IN 2020 IS WHEN WE RECEIVED THAT LETTER THAT I SPOKE ABOUT, THE COMPANION LETTER THAT WAS SENT TO BETH KIDDER. AND THEN IN 2023, WE RECEIVED 184 PAGE GUIDE, A NEW COMPREHENSIVE MEDICAID GUIDE FROM THE FEDERAL GOVERNMENT. SO THESE ARE ALL THE FEDERAL RULES. SO IN ORDER TO BE IN COMPLIANCE WITH THESE NEW FEDERAL RULES THAT CAME OUT IN MAY OF 2023, THEY HAVE TO BE IMPLEMENTED BY JULY 1st, 2026. WE HAVE TO HAVE A SPA APPROVED BECAUSE THEY ARE GOING
024TO PAY US BASED ON OUR EXPENDITURES AS OPPOSED TO PAYING US BASED ON OUR FEE FOR SERVICE. SO IN ORDER TO GET PAID THAT WAY, WE HAVE TO SUBMIT A SPA. HAVE WE DONE THAT? KNOWING THAT IT'S 15 TO 18 MONTHS THAT IT TAKES TO GET ONE APPROVED? NO. THE STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, HAS NOT DONE THIS YET AS OF TODAY'S DATE. AND WE ARE VERY MUCH PAYING ATTENTION TO WHAT THEY ARE DOING. INITIATIVES. THAT'S THE PROGRAMS THAT WE HAVE. THAT'S PART OF THE PROBLEMS THAT WE NEED. AND THESE ARE OUR INITIATIVES THAT WE'RE GOING TO GO AFTER. WE WANT TO BRING A CAMPAIGN AND IT STARTS TODAY, BRINGING AWARENESS OF WHAT WE CAN DO FOR OUR SCHOOLS. THIS ISN'T FOR HILLSBOROUGH COUNTY PUBLIC SCHOOLS. THIS IS FOR OUR KIDS BECAUSE
025THEY NEED TO BE ENROLLED. THEY NEED TO HAVE INSURANCE, AND WE GET REIMBURSED FOR EXPENSES WE'VE ALREADY PAID. SO WE'RE ALREADY DOING THE WORK. I'M STARTING TO GET PASSIONATE. AND WE'RE COLLABORATING WITH OTHER DEPARTMENTS, LIKE WE'RE COLLABORATING WITH FACE, SOCIAL WORKERS, MYRNA IS HERE TODAY. SO HAPPY TO SEE THAT. STUDENT SERVICES. SO WE WORK WITH ALL THE OTHER DIVISIONS. WE'RE GOING TO HAVE COMMUNITY ENGAGEMENT, AND WE HAVE TO CREATE EFFICIENCIES. THANK YOU FOR HIRING JAMIE, SERIOUSLY. WE ARE GOING TO MAKE THIS WORK. OUR DATA REPORTS ARE GOING TO BE BETTER. WE'RE GOING TO CREATE A BETTER PROCESS FLOW. SO DO WE WANT TO WAIT UNTIL 2026 TO GET THE EXTRA DOLLARS? NOT IF WE DON'T HAVE TO. SO WHAT WE HAVE DECIDED IS WE ARE ALLOWED TO DO A RATE STUDY. SO I SPOKE ABOUT
026TRANSPORTATION EARLIER, BEING ABLE TO GET REIMBURSED FOR TRANSPORTATION. I DON'T WANT TO TELL YOU WHAT OUR RATE IS RIGHT NOW, HOW MUCH WE GET TRANSPORTING A STUDENT TO A SERVICE. BUT WE DO KNOW THERE IS THE OPPORTUNITY TO DO A RATE STUDY AND INCREASE HOW MUCH WE MAKE. I KNOW LEVY COUNTY JUST SUBMITTED ONE FOR $19 A RIDE. I DID IT IN BROWARD COUNTY AND WE WENT FROM $3 TO I THINK IT WAS $13 AT THE TIME, SOMETHING LIKE THAT. SO WE'RE GOING TO DO THAT HERE. AND WE'RE GOING TO DO THAT WITH OTHER NURSING AND OCCUPATIONAL THERAPY AND THE OTHER GROUPS AS WELL TO SEE HOW MUCH WE CAN INCREASE THE RATES. WE'LL NEVER GET WHAT WE SPEND. THEY'LL NEVER COME TO THAT POINT. WE HAVE TO HAVE THAT COST RECONCILIATION PROGRAM IMPLEMENTED BY
027AHCA. BUT IN THE MEANTIME, WE'RE GOING TO TRY TO MAXIMIZE OUR REIMBURSEMENT. SO THE BOARD SUPPORT, JUST HAVING YOU SIT HERE LISTENING AND UNDERSTANDING WHAT I'M SAYING IS HUGE SUPPORT, BECAUSE NOW YOU CAN SPEAK ABOUT IT. YOU CAN TALK ABOUT IT IN YOUR CIRCLES. YOU COULD SPEAK TO YOUR STATE REPS ABOUT IT. LET ME STICK TO THE SCRIPT. WE COULD INCREASE THE BUDGET FOR SCHOOL-BASED SERVICES. SO IN ORDER TO GET THIS EXTRA ESTIMATED $200 MILLION FOR FLORIDA SCHOOL DISTRICTS, OUR BUDGET RIGHT NOW IS A HUNDRED MILLION. SO AHCA HAS TO REQUEST A $200 MILLION INCREASE. WE HAVE YET TO SEE THAT. SO WE NEED TO SUPPORT THAT INCREASE. USUALLY WE DON'T WANT TO SUPPORT BUDGET INCREASES, BUT THIS IS FEDERAL DOLLARS. IT'S NOT EVEN STATE DOLLARS THAT WE'RE GETTING. IT'S FEDERAL DOLLARS. WE NEED TO
028HAVE AHCA SUBMIT AND GET A STATE PLAN AMENDMENT APPROVED, AND WE ALSO NEED TO DEVELOP AN INTERAGENCY AGREEMENT TO DETERMINE BETWEEN THE STATE MEDICAID AND DEPARTMENT OF EDUCATION. BY LAW, WE ARE SUPPOSED TO HAVE THAT. WE DO NOT. WE NEED TO KNOW WHOSE ROLES ARE WHAT. WE WORK VERY CLOSELY WITH THE DEPARTMENT OF EDUCATION. THEY HAVE A TEAM UP THERE THAT HELPS US. SO WE JUST NEED TO WORK WITH THEM AND HAVE AN INTERAGENCY AGREEMENT BETWEEN THE DEPARTMENT OF HEALTH AND THE AGENCY FOR HEALTH CARE ADMINISTRATION. THAT'S REALLY IT. WHAT I WENT OVER TODAY. I HOPE YOU ALL LEARNED SOMETHING. I'M READY FOR YOUR QUESTIONS OR HE IS. Jessica Vaughn: THANK YOU SO MUCH. MEMBER PEREZ. [MICROPHONE NOT ON] [INAUDIBLE] HOW MUCH DO WE BILL? ARE YOU SAYING HOW MANY SERVICES? HOW MUCH MONEY? Karen
029Perez: [INAUDIBLE] SO WE HAVE TWO DIFFERENT PROGRAMS. THE ONE THAT IS -- SO LAST YEAR WE BROUGHT IN ABOUT $6 MILLION, WE BROUGHT IN LAST YEAR. Karen Perez: [INAUDIBLE] WELL, THERE ARE DIFFERENT ESTIMATES, BUT WE BELIEVE THAT WE SHOULD BE BRINGING IN AT LEAST $10 MILLION MORE. ANNUALLY. JUST FOR CLARIFICATION, THAT'S IF THE NEW POLICIES IS ADOPTED BY THE STATE OF FLORIDA. YES. Jamie Lewis: IF THAT WAS TO HAPPEN, ALMOST AUTOMATICALLY FOR THE SAME LEVEL OF WORK THAT WE'RE ALREADY DOING, THAT MONEY WOULD JUST INFLOW TO OUR DISTRICT. UNTIL THEN, AND AS YOU HEARD, THE SPA TAKES QUITE A BIT OF TIME. IF YOU WERE TO COUNT THE MONTHS FROM NOW UNTIL JULY OF 26, WE ALREADY PASSED THAT TIME PERIOD. SO BECAUSE OF THAT AND THROUGH PREVIOUS CHALLENGES WITH THE STATE BEING OUT OF
030COMPLIANCE, WE'RE GOING TO START THE RATE STUDIES. HOPEFULLY WE KNOW WHERE WE'RE AT NOW. WE HAVE A THRESHOLD, AND WE'LL START TO SEE THAT TRICKLE UP BECAUSE WE'LL DO THE RATE STUDIES. WE'LL NEVER GET TO WHERE WE WANT TO BE BECAUSE WE'LL NEVER BE ABLE TO DO ENOUGH STUDIES TO MAXIMIZE THAT, BUT WE'LL TRY TO DO OUR BEST TO DO MORE THAN WE'RE DOING NOW. MS. DINEEN HAS EXPERIENCE IN ANOTHER COUNTY WHERE THEY DID THAT AND SAW SOME REAL GAINS IN A VERY QUICK MANNER. Karen Perez: [INAUDIBLE] YES. Karen Perez: [INAUDIBLE] YES. FOR SURE, YES. Karen Perez: [INAUDIBLE] SO FOR THE FEE FOR SERVICE PROGRAM, WE DON'T CODE IT. WE JUST CHECK COMPLIANCE. WE HAVE A VENDOR THAT I USED TO USE WHEN I WAS IN BROWARD AND I WAS HAPPY TO SEE THAT HILLSBOROUGH
031USED THEM TOO. WHEN I CAME HERE, IT MADE IT SO MUCH EASIER FOR ME. AND THEY ARE A DOCUMENTATION SYSTEM. AND FROM THAT, WE CHECK COMPLIANCE. THEY HAVE COMPLIANCE CHECKS, AND THEN WE SUBMIT IT TO MEDICAID. Karen Perez: [INAUDIBLE] YES, VERY IMPORTANT. Karen Perez: [INAUDIBLE] YES, YES. WE DON'T WANT TO SUBMIT ANYTHING WE'RE NOT SUPPOSED TO. Jessica Vaughn: [INAUDIBLE] Lynn Gray: THANK YOU, MADAM CHAIR, AND THANK YOU, DINEEN AND JAMIE LEWIS AS WELL. LEARNING A LOT. THANKS THAT YOU'RE HAVING A RATE STUDY BECAUSE THAT IS GOING TO BE REALLY IMPORTANT. I ALWAYS LOOK FOR THE SILVER LINING IN THE CLOUDS. I KNOW KRISTIN DAVIS IS NOT HERE OR UP FRONT TO MENTION -- I SEE HER -- RECENT LEGISLATION. BUT IN REAL-TIME, WE'RE LOOKING AT LOWERING THE REIMBURSEMENT TREMENDOUSLY. WHY I ASK FOR SEVERAL REASONS,
032THE FIRST THING IS, AS MEMBER PEREZ ALLUDED TO, WE USE SOME OF THAT REIMBURSEMENT FOR SALARIES. MENTAL HEALTH, FOR SOME OF OUR STAFF MEMBERS, THE SALARIES. IS THAT CORRECT? I'M NOT A HUNDRED PERCENT SURE. SAYS IT IS A TRUE REIMBURSEMENT PROGRAM. IT GOES BACK TO THE GENERAL FUND WHERE THE FUNDS ARE. I GUESS YOU COULD SAY UNDERLYING HELPS THE DISTRICT PROVIDE THESE. I THINK WHAT'S REALLY IMPORTANT IS WHETHER WE GET THIS REIMBURSEMENT OR NOT, THESE SERVICES WILL ALWAYS CONTINUE. I DON'T ALWAYS LINK THE MONEY RIGHT BACK TO REIMBURSEMENT TO THE SALARIES BECAUSE WE'LL DO THIS REGARDLESS FOR OUR STUDENTS. IT IS NICE TO GET REIMBURSED BECAUSE THAT HELPS. BUT JUST TO ENSURE EVERYONE THAT WE'LL CONTINUE THESE SERVICES FOR THESE KIDS, WHETHER WE'RE REIMBURSED FOR THESE SERVICES OR NOT BECAUSE THAT'S A COMMITMENT THAT THE
033DISTRICT HAS. Lynn Gray: SO WE HAVE LIKE A COLUMN HERE, YES, YOU'RE GOING TO DO THE RIGHT THING FOR OUR CHILDREN. THE OTHER REALITY IS, THE GENERAL FUND, THERE WILL BE OTHER CONSEQUENCES TO EMPLOYEES OF OUR DISTRICT. WE'RE TALKING ABOUT A LOSS. AND HOW MUCH DO WE ANTICIPATE -- YOU MENTIONED TECHNOLOGY ASSISTED DEVICES, TRANSPORTATION FOR ESE. THEY ARE VERY COSTLY. DO WE ANTICIPATE ANY LOSSES TO HELP THOSE PROGRAMS, TO HELP THOSE ESE KIDS WHO HAVE TREMENDOUS DISABILITIES THROUGH THIS POSSIBLE TIME OF DEFICIT? I DON'T BELIEVE THE KIDS ARE GOING TO BE IMPACTED TOO MUCH. I MEAN, THERE WILL BE A CHANGE, BUT MY PERSONAL BELIEF IS PROBABLY OPTIMISTIC THAT THEY'LL STILL TAKE CARE OF OUR MEDICALLY FRAGILE AND STUDENTS THAT ARE ESE. I THINK LIKE ANY CHANGE THAT MIGHT BE COMING FOR OUR DISTRICT, IT'S
034SOMETHING WE NEED TO MONITOR AND WORK CLOSELY. I THINK ONE OF THE POINTS THAT MS. DINEEN MENTIONED, SOMETHING FINANCE IS DOING NOW, WORKING VERY CLOSELY WITH OTHER DEPARTMENTS. MS. TRACYE BROWN IS HERE. WE REACHED OUT AND WORKED WITH HER, EVEN BEFORE I GOT HER, MS. DINEEN WAS WORKING WITH HER TO BUILD THE RELATIONSHIPS. IT IS A KEY PARTNERSHIP UNDERSTANDING WHAT IS HAPPENING IN THE SCHOOLS AND THE SERVICES WE'RE PROVIDING AND MAKING SURE WE'RE SEEING THAT ON OUR END, THE BACK END, AND THE DISTRICT IS COLLABORATING AND WORKING TOGETHER TO ENSURE THAT WE'RE MAXIMIZING BOTH THE CARE FOR OUR STUDENTS AND THIS PROGRAM. Lynn Gray: YEAH, AND IT IS SO TRUE. YOUR PRESENTATION IS VERY MUCH HEARTFELT AND APPRECIATED IN EVERY WAY POSSIBLE. BUT THE REALITY IS, AND WHEN WE LOOK AT THE SCHOOL-BASED MEDICAID AND
035LOSS OF FEDERAL REIMBURSEMENT, WE ONLY GO DOWN TO MAY 2023, BUT, IN FACT, WE'RE LOOKING AT '24, '25, '26 WHERE WE ARE -- WE WILL GET LESS REIMBURSEMENT. AND HENCE YOU'RE GETTING TO THE RATE STUDY WHICH IS IMPORTANT NO DOUBT. BUT THAT REALITY WILL AFFECT GROUPS OF STUDENTS, NOT ONLY THE ESE, BUT WHAT OTHER GROUPS DO WE HAVE THAT WILL BE AFFECTED IF WE HAVE TO ENSURE MORE CUTS TO MEDICAID? I DON'T THINK THAT WE'RE GOING TO HAVE CUTS. IN THIS PROGRAM. IN FACT, WE'RE SUPPOSED TO INCREASE OUR REIMBURSEMENT BECAUSE WE HAVEN'T BEEN PAID AT THE RIGHT RATE FOR ALL THESE YEARS AND WE'VE BEEN OUT OF COMPLIANCE. SO IF WE CAN GET THE AGENCY FOR HEALTH CARE ADMINISTRATION TO DO THEIR JOB AND SUBMIT A SPA, AND WE COULD START GETTING REIMBURSED BASED ON
036OUR EXPENSES, WHICH ARE WAY MORE THAN WHAT WE'RE GETTING REIMBURSED NOW. Lynn Gray: YEAH, EXPENSES ARE OUTWEIGHING WHAT WE ARE GETTING REIMBURSED, SENSE THAT IS A DEFICIT. I'M NOT A DEBBIE DOWNER, BY THE WAY, BUT I HAVE TO SAY, FROM WHAT I'M READING IN THE LEGISLATURE, AS THINGS ARE COMING DOWN, YES, JAMIE. Jamie Lewis: I WAS GOING TO SAY, I THINK TO YOUR POINT, MS. DINEEN MENTIONED THAT THE STATE OF FLORIDA NEEDS A REQUEST TO THE FEDERAL GOVERNMENT, AN INCREASE IN BUDGET. THAT'S A NUMBER TO WATCH. SO IF THAT INCREASES, THEN THAT ALLOWS DISTRICTS TO RECEIVE MORE MONEY. IF THAT NUMBER WAS TO DECREASE, TO YOUR POINT, I THINK THAT'S WHEN DISTRICTS MIGHT BE NEGATIVELY AFFECTED WITH THE REIMBURSEMENT PROGRAM BECAUSE THERE'S LESS MONEY TO PUSH OUT TO THE DISTRICTS. THAT BUDGET IS A REALLY
037IMPORTANT NUMBER AT THE STATE LEVEL BECAUSE WITH ALL THE CHANGES OCCURRING, HOW THAT NUMBER FLUCTUATES WILL DETERMINE WHAT HAPPENS AT THE DISTRICT LEVEL FOR ALL DISTRICTS IN THE STATE OF FLORIDA. Lynn Gray: I WAS LOOKING AT ORANGE COUNTY. THIS IS A TOPIC THAT'S NOT JUST HERE, IT'S IN OTHER COUNTIES THAT THEY ARE VERY AWARE OF WHAT MAY BE SEEN AS A TREMENDOUS DEFICIT WHICH THEN MINUSES FROM OUR GENERAL FUND WHICH THEN AFFECTS MANY, MANY THINGS. TRACYE BROWN, I DON'T HAVE TO TELL YOU, BUT YOUR TITLE I, TITLE II, TITLE IX ALSO AFFECTED. I'LL ASK ONE MORE QUESTION. ESE MAY BE AFFECTED. LET'S JUST SAY MAYBE. AND THEN WE HAVE WHAT IS CALLED FACE, FAMILY AND COMMUNITY ENGAGEMENT, IS WHICH INTERFACES WITH FAMILIES WHO ARE VERY, VERY AWARE OF WHAT MAY BE MINUSSED IN THEIR INCOMES
038IF THEY ARE ON MEDICAID, SHALL I SAY PROGRAM. SUPERINTENDENT VAN AYRES, WHERE WOULD FACE BE USED TO HELP OUR FAMILIES NAVIGATE WHAT MIGHT BE NEW WAYS TO GET REIMBURSED? Van Ayres: PART OF FAMILY AND COMMUNITY ENGAGEMENT. IT IS AN OPPORTUNITY TO BE OUT IN OUR COMMUNITIES AND INFORM AND EDUCATE OUR FAMILIES AROUND THESE MEDICAID OPPORTUNITIES. JAMIE'S TEAM HAS BEEN WORKING WITH OWEN'S TEAM IN MAKING SURE THAT WE ARE OUT IN CERTAIN SEGMENTS OF OUR COMMUNITY BECAUSE I THINK IT'S PRETTY TARGETED WHICH COMMUNITIES THAT WE'RE LOOKING AT SO WE CAN INFORM AND EDUCATE THEM AROUND THAT MEDICAID ENROLLMENT. Lynn Gray: LAST QUESTION. LET ME SQUEEZE ONE MORE IN. MANY OF THE GROUPS WE HAVE HISPANIC, I'LL JUST POINT THAT OUT, WHICH MAY TOTAL 48% STUDENT. MANY OF THEM ARE FACING OR LOOKING AT POSSIBLE MEDICAID FUNCTIONALITIES
039BEING DECREASED. SO ONE OF THE PROBLEMS THAT WE'RE FACING IS THE DIGITAL PART. DINEEN, YOU CAN'T FIX THIS, BUT THE REALITY IS OUR HISPANIC FOLKS AND MANY DON'T EVEN KNOW HOW -- I HATE TO SAY IT -- BUT MANY DON'T EVEN HAVE A COMPUTER. THEY DON'T HAVE THE WHEREWITHAL TO NAVIGATE INTRICACIES OF BUREAUCRACY. HOW ARE WE PREPARED TO HELP THEM? SO WE HAVE THE MEMORANDUM OF AGREEMENT WITH THE FAMILY HEALTH CARE FOUNDATION. IN FACT, THEY ARE HERE TODAY. WE'RE A PARTNERSHIP WITH THEM. SO THEY HAVE THE PEOPLE THAT ARE TRAINED, AND THEY ALSO HAVE IT IN DIFFERENT LANGUAGES. THEY HAVE MEDIA TOOL KITS. THEY GO OUT TO DIFFERENT SITES. THEY ARE WELL TRAINED AND WELL EDUCATED AND KNOW HOW TO ENROLL OUR FAMILIES. AND THEY GO OUT TO DIFFERENT EVENTS TO ENROLL OUR FAMILIES. SO
040WE'LL GET MORE INTO THAT AND MAKE THAT A BIGGER PRIORITY BECAUSE WE KNOW THAT THE KIDS NEED INSURANCE AND WE WANT THEM TO BE ENROLLED AND WE BENEFIT FROM IT. BUT REALLY, IT'S GETTING THEM INSURED. Lynn Gray: THANK YOU FOR EVERYTHING. YOU'RE WELCOME. Jessica Vaughn: THANK YOU, MEMBER GRAY. DR. HAHN. Stacy Hahn: THANK YOU. SO IN 2020, THE LETTER CAME OUT THAT SAID NO MORE FEE -- YOU COULDN'T USE A FEE SCHEDULE. WHY DO YOU THINK SINCE THEN THE FEDS HAVEN'T ENFORCED THE FIVE STATES TO COMPLY? BECAUSE THEY HAVE NO TEETH. WE SPOKE WITH THEM. THE CENTERS FOR MEDICAID AND MEDICARE HAVE NO TEETH, BASICALLY WHAT THEY SAY. THEY CANNOT ENFORCE IT, BUT HHS CAN. SO WE MEET WITH CMS QUITE OFTEN. THE LAST TIME WE MET WITH THEM, WE ASKED THEM LIKE FIVE DIFFERENT
041COUNTIES, PINELLAS, LEON, HILLSBOROUGH, BROWARD, WE ALL WENT UP TO THEM SEPARATELY AND SAID WHAT CAN WE DO? WE HAVE TO MOVE -- WE HAVE TO HAVE THEM DO SOMETHING. SHOULD WE CALL HHS? HE'S LIKE, WELL, DO YOU WANT HHS TO COME AND LOOK AT YOUR PROGRAM? THAT'S A DECISION THE SCHOOL DISTRICTS NEED TO MAKE. I DON'T THINK THAT WE'RE THERE YET. I THINK WE HAVE OTHER AVENUES LIKE SPEAKING TO OUR LOBBYISTS AND WORKING THROUGH KRISTIN DAVIS AND TRYING TO GET THEM TO DO WHAT THEY ARE SUPPOSED TO DO. Stacy Hahn: SO YOU TALKED ABOUT DOING A RATE STUDY. IS THAT SOMETHING WE WOULD HIRE A CONSULTANT FOR OR DO WE DO THAT INTERNALLY? WE'LL DO IT INTERNALLY, YES. Stacy Hahn: WE ALSO TALKED ABOUT OUR CURRENT PARTICIPATION RATE. I THINK YOU SAID THE GOAL WAS
042-- 95 TO 100 PERCENT. Stacy Hahn: WHERE ARE WE? 95 TO 100 PERCENT. ONE MONTH WENT A LITTLE LOWER. I HAD LOST THE PERSON WHO HAD BEEN DOING IT FOR MANY, MANY YEARS. SHE RETIRED. BUT WE'RE GETTING BACK THERE AGAIN. IT'S ABOUT 95 TO ALMOST 100 PERCENT. Stacy Hahn: THANK YOU. Jessica Vaughn: MEMBER COMBS. Nadia Combs: I HAD A COUPLE OF QUESTIONS. THANK YOU FOR THE INFORMATION. THERE'S JUST SO MANY FACTORS. AS A BOARD MEMBER, WE DON'T KNOW EVERYTHING. THIS IS SOMETHING I'VE LEARNED A LOT ABOUT JUST THROUGH READING THIS FOLDER. I GUESS ONE OF THE QUESTIONS IS, WHAT WOULD THE STATES ACTUALLY HAVE TO DO OR OUR STATE IN PARTICULAR, WHAT DO THEY NEED TO DO IN ORDER TO BE COMPLIANT? WHAT WE NEED TO DO ARE A FEW THINGS AND WE CAN'T DO
043ANY OF IT. Nadia Combs: WHAT WOULD THE STATE HAVE TO DO? WHAT THEY HAVE TO FIRST DO IS SUBMIT A SPA. SO THEY HAVE TO CHANGE IT. SO THE SPA WOULD SAY WE'RE NO LONGER GOING TO BE PAID ON A FEE SCHEDULE. WE'RE GOING TO BE IN COMPLIANCE AND PAID BASED ON OUR EXPENDITURES. AND THEN THEY HAVE TO COME UP WITH WHAT DOES IT LOOK LIKE IN REALITY FOR US? SO WHAT DO WE HAVE TO DO DIFFERENTLY? COST REPORTS. WE'LL HAVE THAT SURVEY I TOLD YOU ABOUT. WE HAVE A THREE-QUESTION SURVEY. WE'LL HAVE TO HAVE PROBABLY TWO COST POOLS INSTEAD OF ONE. SO IT'S GOING TO BE A LITTLE MORE WORK, BUT IT WILL DEFINITELY BE WORTH IT. THE WORK WILL BE MOSTLY INTERNALLY, NOT SO MUCH ON THE STAFF AT SCHOOLS. SO THAT'S WHAT
044WE WOULD HAVE TO DO. WE WOULD HAVE TO SUBMIT A SPA. AFTER THE SPA IS APPROVED, THEY HAVE TO PROMULGATE THE RULES. THEY HAVE TO HAVE A RULE-MAKING HEARING, AND THEY HAVE TO GET THAT APPROVED. AND THAT'S GOING TO BE THE RULES THAT THE STATE OF FLORIDA HAS TO FOLLOW. Nadia Combs: DO YOU ANTICIPATE THAT HAPPENING? I ANTICIPATE IT HAPPENING AT SOME POINT. I DO NOT ANTICIPATE IT HAPPENING BY JULY 1st, 2026. Nadia Combs: IT'S BEEN LIKE SEVEN YEARS, RIGHT? ORIGINALLY, 2014, BUT THE GUIDE CAME OUT, THE NEW FEDERAL GUIDE IN MAY OF 2023. SAYING THAT THE WHOLE STATE, NOT JUST FLORIDA, THE NATION, HAS TO USE THIS NEW GUIDE BY JULY 1st, 2026. MOST SCHOOL DISTRICTS, WE HAVE NATIONAL CONFERENCES AND NATIONAL CALLS. I FEEL CONFIDENT I CAN SAY THIS. MOST SCHOOL DISTRICTS ARE
045DOING WHAT THEY NEED TO DO BECAUSE THEY KNOW HOW MUCH MONEY IT BRINGS IN. NEW MEXICO IS AMAZING. DENVER IS AMAZING HOW MUCH MONEY THEY ARE BRINGING IN. BY DOING A COST RECONCILIATION INSTEAD OF GETTING $3 FOR PROVIDING JOHNNY SPEECH THERAPY. IT'S DEFINITELY GOING TO BE BETTER IF WE CAN GET THE AHCA TO DO WHAT THEY ARE SUPPOSED TO DO. Jamie Lewis: TO CLARIFY YOUR QUESTION, IT WAS ISSUED SEVERAL YEARS AGO, AND THAT TIMELINE THAT THE FEDERAL GOVERNMENT APPROACHED GETTING INTO COMPLIANCE FOR THE STATE OF FLORIDA, THAT WAS AN APPROPRIATE TIMELINE IF THEY WOULD HAVE STARTED RIGHT THEN. I THINK THE REASON WE'RE GOING TO DO A STUDY ON SEVERAL DIFFERENT AREAS IS BECAUSE WE HAVEN'T SEEN THE TRACTION WHERE IT NEED TO BE AND THE TIMELINE IT NEEDS TO BE. IT DOESN'T MEAN NOTHING
046IS HAPPENING. IT'S JUST NOT HAPPENING AT THE PACE NEEDED TO HIT THE TARGET FOR 2026. THE QUESTION WOULD BE IS WHEN DOES THE STATE OF FLORIDA ADOPT IT? I WOULD ASSUME IT HAS TO EVENTUALLY, BUT IN THE MEANTIME, WE DON'T WANT TO WAIT UNTIL THAT DATE BECAUSE THAT PUTS US FURTHER BEHIND. WE BELIEVE WE CAN DO SELF-STUDIES HERE IN HILLSBOROUGH TO AT LEAST GET A BETTER RATE UNTIL THE TIME STATE OF FLORIDA DOES BECOME COMPLIANT. Nadia Combs: I'M SURPRISED I HAVEN'T HEARD MORE ABOUT THIS FROM THE FLORIDA SCHOOL BOARD ASSOCIATION. I THINK THIS IS SOMETHING HUGE AND COULD IMPACT ALL THE DISTRICTS. I'M SURPRISED I HAVEN'T HEARD MORE ABOUT THIS. OF COURSE, THEY WOULD BE AWARE AND I WOULD THINK WE WOULD MAKE SURE WE UTILIZE OUR LOBBYIST AND USE IT AS A PRIORITY, ONE
047OF OUR PRIORITIES FOR NEXT YEAR. I'M JUST SURPRISED THAT I FEEL LIKE I'M VERY INVOLVED. THANK YOU, MEMBER PEREZ, FOR BRINGING THIS TO US. THE OTHER QUESTION, ONE OF THE GOALS IS THE OUTREACH. DO WE DO SOMETHING ON THE FIRST-DAY PACKETS FOR THE OUTREACH FOR THE INFORMATION? THE OTHER THOUGHT WOULD BE ON OUR DISTRICT WEBSITE, BUT DEFINITELY ON INDIVIDUAL STUDENT WEBSITES, WHEN YOU KNOW THAT'S GOING TO BE A HIGH AREA LOOKING AT THOSE INDIVIDUAL WEBSITES AND HAVING THOSE FIRST PACKET DAYS TO THINK ABOUT HOW WE CAN REACH OUT. AND THEN I THINK AT EVENTS, WHEN I THINK ABOUT THE DIFFERENT EVENTS THAT WE HAVE, THERE SHOULD ALWAYS MAYBE BE A TABLE OUT THERE TO MAKE SURE WE'RE REGISTERING FAMILIES AND PROVIDING THAT. YES, AGREED. Nadia Combs: IS THERE A REGISTRATION PERIOD OR -- IS THERE
048AN ENROLLMENT PERIOD OR OPEN ANYTIME? I WOULD THINK SOME EVENTS THAT WE GO TO, LIKE THE RACE FOR EDUCATION, ANYTHING THAT WE DO THAT'S GOING TO HAVE A LOT OF FAMILIES THERE, PARENTS THERE, GOING OUT THERE, JUST GIVING THAT INFORMATION AND GETTING THE PARENTS TO ROLL. Jamie Lewis: KEY FOR SEVERAL UNITS INSIDE THE DISTRICT TO BE WORKING TOGETHER ON THIS PROJECT, NOT JUST FINANCE LED. WE'VE BEEN PARTNERING WITH OTHER ONES AS WE MENTIONED EARLIER IN THIS CONVERSATION, MR. OWEN, HIS GROUP WOULD KNOW BEST OF HOW TO ENGAGE. I THINK THE ONE THING WE WANT TO DO IS MAKE SURE FAMILIES FEEL COMFORTABLE WITH WHAT WE'RE TRYING TO DO WITH THE MEDICAID PROGRAM. SOMETIMES FAMILIES ARE HESITANT TO SIGN UP FOR PROGRAMS BECAUSE THEY ARE UNAWARE OF WHAT IT MEANS. WE WANT TO MAKE SURE GUIDANCE
049COUNSELORS AND PRINCIPALS ARE EDUCATED WHERE THEY CAN TALK CLEARLY ABOUT IT AND HELP EXPLAIN THAT BECAUSE THEY WILL BE IN THE CONVERSATIONS WITH THE PARENTS WHERE MAYBE WE DON'T SEE THEM ALL THE TIME. IT'S GOING TO BE MORE OF THE COMMUNITY INTERNALLY. WE CAN DO EDUCATION AND BUILD UP OUR STAFF TO FEEL CONFIDENT ABOUT TALKING ABOUT IT AND THE BENEFITS OF WHAT THIS DOES. THE REALITY IS WE WANT TO MAKE MOM AND DAD FEEL COMFORTABLE WITH WHAT THIS PROGRAM IS, AND TO MAKE SURE THEY ARE REASSURED THEIR CHILD WILL ALWAYS RECEIVE THE SERVICE AND WHAT DOES THIS ACTUALLY MEAN AND IMPACT THEM OR MAYBE I SHOULD SAY DOESN'T IMPACT THEM. Nadia Combs: I THINK CREATING SOME TYPE OF VIDEO WITH THE COMMUNICATION TEAM WITH MULTIPLE LANGUAGES AND SHARING THAT BECAUSE SOMETIMES IT WILL BE THE
050DATA PROCESSOR OR THE FRONT OFFICE STAFF. WHEN PEOPLE COME IN TO REGISTER IN THE MIDDLE OF THE YEAR, OFTEN THE FRONT OFFICE STAFF IS KNOWLEDGEABLE AND PROVIDES THAT INFORMATION. THE PARENT COMMUNITY CENTER, PLACES LIKE THAT WHERE PARENTS ARE GOING JUST TO MAKE SURE. I THINK IF EVERYBODY, ALL HANDS ON DECK, I THINK WE CAN MAKE A BIGGER IMPACT. THANK YOU SO MUCH. Jessica Vaughn: THANK YOU, MEMBER COMBS. MEMBER WASHINGTON. Henry "Shake" Washington: THANK YOU, MADAM CHAIR. I JUST WANT TO REEMPHASIZE BECAUSE WE ALL HAD GREAT POINTS ABOUT THE PROGRAM. AND THANK YOU ALL, BECAUSE I'M NOT THAT FAMILIAR WITH MEDICAID AND I THINK WHAT WE ARE DOING NOW TO IMPROVE IS GOING TO BE SUCCESSFUL FOR ALL FAMILIES. THE RECRUIT PART, LIKE MEMBER COMBS SAID AND MEMBER GRAY, IT'S SO IMPORTANT TO GET TO KNOW
051NEIGHBORHOODS THAT WE DON'T NORMALLY GO INTO BECAUSE WE DO HAVE GREAT DIVISION OR DIVIDE IN THOSE NEIGHBORHOODS BECAUSE THEY DON'T HAVE COMPUTERS IN PARTS OF EAST TAMPA. WE DON'T HAVE THAT. THEY DON'T HAVE THE INFORMATION. WE DON'T HAVE ANYBODY OUT THERE. I THINK FACE WOULD BE SO IMPORTANT FOR ANY OF US. I WOULD BE WILLING TO GO OUT IN THE NEIGHBORHOOD. THAT'S WHERE I WAS BORN AND REARED AT. IT WOULD BE REALLY IMPORTANT FOR US TO GET OUT THERE BECAUSE FAMILIES, NOT NECESSARY THAT THEY DON'T WANT IT. SOMETIMES THEY DON'T WANT TO BE EMBARRASSED. THAT IS A KEY POINT BECAUSE MANY TIMES WHEN YOU'RE OUT WITH THE PRINCIPAL, TITLE I, THEY DIDN'T WANT TO PUT THEIR NAMES DOWN BECAUSE THEY WERE EMBARRASSED. WE HAVE TO FIND A WAY HOW WE CAN GET THEM OUT AND
052TO IMPROVE THAT AND ALSO EXPLAIN IT TO THEM IN DETAIL. BECAUSE WE UNDERSTAND, SOME OF US WE UNDERSTAND, BUT WHEN YOU GO OUT TALKING TO PEOPLE AND SOME PEOPLE DON'T HAVE EDUCATION. THEY JUST DON'T KNOW. YOU'VE GOT TO BREAK IT DOWN IN SIMPLE TERMS SO THEY UNDERSTAND. I THANK YOU ALL AND THE BOARD MEMBERS HAD GREAT POINTS THEY BROUGHT OUT, THE THINGS THAT WE WOULD LIKE TO SEE DONE. THANK YOU. THANK YOU, MADAM CHAIR. Jessica Vaughn: THANK YOU. I'M GOING TO ASK SOME QUESTIONS AND THEN WE HAVE SOME SECOND QUESTIONS BACK IN THE QUEUE. FIRST OF ALL, THANKS FOR THE PRESENTATION. MY FAVORITE THING IS WHAT CAN BOARD MEMBERS DO AND BOARD SUPPORT? RIGHT? LIKE, I LOVE THAT BECAUSE IT GIVE US A DIRECT -- AN IDEA SPECIFICALLY IN OUR ROLES OF WHAT WE CAN
053DO AND HOW WE CAN ADVOCATE. IT'S ALL HELPFUL BUT THAT PIECE IS SPECIFICALLY HELPFUL. Jamie Lewis: THERE IS A SHEET IN THE BACK OF THE FOLDERS THAT WE MENTIONED IN THE PRESENTATION. WE KIND OF GAVE YOU A ONE-SHEET THEY'RE GIVES YOU MORE DETAILS. YOU HAVE THAT READILY AVAILABLE SO YOU DON'T HAVE TO LOOK THROUGH THE WHOLE PRESENTATION. Jessica Vaughn: THANK YOU, MEMBER PEREZ, FOR BRINGING THIS FORWARD SO WE COULD BE EDUCATED ABOUT THIS. I REMEMBER THAT YOU WROTE DOWN YOU SAID 40% OF OUR FAMILIES PARTICIPATE IN MEDICAID. IS THAT IN HILLSBOROUGH COUNTY OR STATEWIDE? THAT WAS STATEWIDE, BUT IT'S ACTUALLY THE SAME. IT'S A LITTLE BIT LESS IN HILLSBOROUGH COUNTY. IT'S LIKE 39%. Jessica Vaughn: JUST TO KIND OF TAKE WHAT YOU'VE PRESENTED, 40% OF OUR FAMILIES, WHICH IS ALMOST HALF, LIVE UNDER A RATE
054FOR A FAMILY OF FOUR BRINGING IN $45,000 A YEAR. LIKE, I THINK THAT IS A REALLY IMPORTANT TAKEAWAY FROM THIS SPECIFICALLY IS THAT IS SHOCKING, AND EYE OPENING, AND SHOULD KIND OF GUIDE A LOT OF OUR CONVERSATIONS GOING FORWARD. I'M ALSO A LITTLE BIT CONFUSED WHEN YOU SAY PARTICIPATION RATE, DOES THAT MEAN THE FAMILIES WHO HAVE MEDICAID ARE USING THE SERVICE? DOES THAT MEAN FAMILIES THAT WE'VE IDENTIFIED THAT FALL WITHIN THAT INCOME RANGE ARE TAKING MEDICAID? WHAT IS SPECIFICALLY THE PARTICIPATION RATE? SO THAT REFERS TO THE RANDOM MOMENT IN TIME SAMPLE. WE SEND OUT BETWEEN 80 TO 90 EVERY QUARTER. SO IN ORDER TO GET 100%, IF WE SEND OUT 90, THEN WE WOULD WANT TO GET 90 BACK. THAT WOULD BE 100% PARTICIPATION. OUT OF HOWEVER MANY WE SEND OUT THAT QUARTER, WE HAVE
055TO GET THE 75% PARTICIPATION RATE. WE'RE NEVER CLOSE TO THAT, THANK GOD, BUT IT WILL CHANGE TO 85%. Jessica Vaughn: WHICH WE'RE ALREADY MEETING. WE ARE. BUT IT WILL ALSO CHANGE TO A TWO DAY, THEY HAVE TO RETURN IT IN TWO DAYS. RIGHT NOW THEY HAVE SEVEN DAYS TO RETURN IT. AND THEY ARE INCHING UP TO THAT EXPIRATION TIME. Jessica Vaughn: THAT IS A HUGE. IT IS A LOT OF WORK TO DO IN TWO DAYS. YES. IT'S NOT GOING TO BE IMPLEMENTED UNTIL AUGUST, BUT THE NEXT QUARTER WE'RE GOING TO JUST LET THEM KNOW YOU HAVE TWO DAYS AND JUST TRACK IT TO START THEM GETTING ON IT EARLY EVEN THOUGH THERE WON'T BE ANY REPERCUSSIONS YET. Jamie Lewis: ON THE FINANCE TEAM, WE'RE BRACING FOR THE CHANGES. IF THE ADOPTION OF GETTING IN COMPLIANCE
056HAPPENS, THERE WILL BE MORE THINGS WE HAVE TO DO ON THE BACK END. THE FINANCE TEAM IS ALREADY HAVING CONVERSATIONS ABOUT HOW WE CAN SUPPORT THAT. THE SEVEN TO TWO DAY TURNAROUND, FINANCE WILL BE MORE ENGAGED WORKING WITH THOSE AT THE SCHOOL SITES TO MAKE SURE WE CAN HAVE THAT TURNAROUND OCCUR SO WE DON'T SEE OUR PARTICIPATION RATE DROP. Jessica Vaughn: WHERE IS THAT CHANGE COMING FROM? THE PARTICIPATION CHANGE, THE 10% JUMP AND THE TWO-DAY TURNAROUND, WHAT IS DRIVING THAT CHANGE? THE NEW GUIDANCE THAT CAME OUT IN MAY OF 2023 BY THE CENTERS FOR MEDICARE AND MEDICAID. Jessica Vaughn: BUT IF THE STATE ISN'T FOLLOWING AND IN COMPLIANCE ABOUT THAT AS FAR AS THE FEE SCHEDULE CHANGING TO BE 100% REIMBURSEMENT INSTEAD OF USING FEE SCHEDULES, HOW CAN WE ENFORCE SOME PART OF THE COMPLIANCE
057BUT NOT THE PIECE THAT BRINGS IN THE FUNDING? SO IT WOULD BE BENEFICIAL FOR US TO KEEP THE SEVEN DAYS. SO IF THEY DECIDE BECAUSE WE HAVE MORE DAYS TO GET THAT FORM BACK BECAUSE WE'RE ALWAYS CALLING THE SCHOOL OR SENDING AN E-MAIL, WE NEED YOU TO ANSWER THE THREE QUESTIONS AND SEND IT BACK. SO IT WOULD BE BETTER TO KEEP THE SEVEN DAYS, BUT WE'RE MOVING TO THE TWO. BUT IF WE DON'T, IF THEY DON'T IMPLEMENT IT, IT WILL BE BETTER FOR US. BUT IF THEY IMPLEMENT PART OF THE NEW RULES, I'M NOT SURE HOW THAT WORKS, IF THEY ARE ALLOWED TO IMPLEMENT PART. Jessica Vaughn: WHO IS THEY? THE STATE? AHCA. THE AGENCY FOR HEALTH CARE ADMINISTRATION. THEY ARE RESPONSIBLE. Jessica Vaughn: THEY WOULD BE IMPLEMENTING CHANGES IN ACCOUNTABILITY BUT NOT BUILDING IN
058THE INFRASTRUCTURE TO RESPOND TO THE FEE SCHEDULE CHANGE THAT WOULD GIVE US MORE REIMBURSEMENT. WELL, THEY HAVE TO SUBMIT A SPA. IN THAT SPA WOULD HAVE CHANGING IT FROM THE SEVEN DAYS WE CURRENTLY HAVE TO THE TWO DAY. IF THEY ARE NOT SUBMITTING A SPA. Jessica Vaughn: THAT'S THE QUESTION I'M ASKING FOR. IT WOULD ALL COME TOGETHER. THOSE CHANGES WOULD ONLY HAPPEN IF THEY SUBMITTED THE ENTIRE DOCUMENT AND THEN WE MOVED FROM THE FEE SCHEDULE TO THE REIMBURSEMENT. I'M HOPING. I CAN'T GUARANTEE. I DON'T KNOW WHAT THEY ARE GOING TO DO. Jamie Lewis: IN THEORY, YES, THAT'S CORRECT. THEY ARE FUNDAMENTALLY CHANGING HOW THE PROGRAM IS HELD IN THE STATE OF FLORIDA. Jessica Vaughn: OKAY. NOW, IS THIS SOMETHING -- I UNDERSTAND THERE'S A LOT OF BUREAUCRACY, AS YOU'VE ALLOCATED FOR BOARD MEMBERS, IS THIS
059SOMETHING THE GOVERNOR COULD JUST SEND OUT SOMETHING AND FORCE THIS TO HAPPEN FOR US TO BE IN COMPLIANCE? DOES THIS HAVE TO GO THROUGH LEGISLATION? HE OVERSEES OUR MEDICAID OFFICE, RIGHT, SO IT WOULD COME DIRECTLY FROM HIS OFFICE? WHO WOULD BE MORE EFFECTIVE? THE LEGISLATION OR THE GOVERNOR, IN MAKING THIS HAPPEN? PROBABLY BOTH. MAYBE KRISTIN WOULD BE BEST TO ANSWER THAT QUESTION. THANK YOU. GOOD MORNING. SO WE ARE STARTING TO RAMP UP SOME WORK INTERNALLY HERE WITH SOME OF DINEEN'S COLLEAGUES AROUND THE STATE, LEON COUNTY, BROWARD COUNTY, OTHER FOLKS, BRINGING IN YOUR LOBBYISTS THAT YOU KNOW WELL AND GETTING THEM UP TO SPEED ON THIS. WHAT I CAN SAY, WITH AHCA IS YOU PROBABLY KNOW, AT LEAST WITH AHCA AND THE GOVERNOR, THERE'S ALSO BEEN KIND OF ANOTHER ISSUE GOING ON IN TERMS OF WITH
060HOPE FLORIDA AND THINGS LIKE THAT. WE'RE GOING TO STILL CONTINUE TO DO WHAT WE'RE DOING, BUT I KNOW THAT'S BEEN SUCKING UP A LOT OF THE BANDWIDTH IN RELATIONSHIPS. SO IN TERMS OF -- THERE IS A LIST. Jessica Vaughn: I'LL GET WITH YOU ABOUT THAT AFTERWARDS. ONE OF THE THINGS I HAVE A QUESTION ABOUT AS WE LOOK TO -- THANK YOU, MS. DAVIS -- ENHANCE OUR CHILDREN WHO ACCESS TO IT AND WE'RE TALKING ABOUT THE VIDEO WAS A GREAT IDEA. I KNOW LIKE, AND I KNOW THERE'S NOT CONSISTENCY, BUT WHEN MY SON BRINGS HOME A PACKET, THERE'S ALWAYS THE MEDICAID FORM IN HIS FIRST AID PACKET IF THAT'S SOMETHING FAMILIES NEED TO TAKE ADVANTAGE OF. I THINK TWO YEARS AGO, THE STATE DID A PURGE WHERE EVERYONE WAS FORCED TO REENROLL. I KNOW WE LOST
061A LOT OF FAMILIES ON MEDICAID DURING THAT PROCESS. IS THERE A WAY TO GET ACCESS TO THAT LIST AND COMPARE IT TO THE FAMILIES WE HAVE TO SEE THE FAMILIES THAT DIDN'T REENROLL AND MAKE A DIRECT ATTEMPT TO CONTACT THEM SPECIFICALLY? CAN WE CROSS-REFERENCE THAT LIST? THERE ARE. THERE ARE NUMBERS FLOATING AROUND OUT THERE. AND THEY CALL IT UNWINDING. SO DURING COVID, NO ONE LOST COVERAGE. EVERYONE STAYED COVERED. THEY DIDN'T HAVE TO REAPPLY. THEN I THINK IT WAS MAY OF 2023 OR APRIL, THEY STARTED THE UNWINDING. BASICALLY PARENTS HAD TO REENROLL AGAIN. THEY HAD TO SHOW WHAT THEIR INCOME LEVELS WERE, FILL OUT AN APPLICATION AND WORK TO GET COVERED. SO WHAT WE'RE SEEING OR WHAT WE'RE HEARING ARE THAT WE LOST ABOUT 30,000 CHILDREN. Jessica Vaughn: STATEWIDE OR COUNTY? HILLSBOROUGH. HOWEVER, WORKING WITH THE
062SCHOOL NUTRITION PROGRAM, SHANEY HALL I THINK HER NAME IS, SHE HAD SOME NUMBERS THAT I THINK ARE WAY MORE REALISTIC. THEY ARE ABOUT -- SO IT HAS EACH SCHOOL, AND IT SHOWS HOW MANY KIDS WENT FROM FREE LUNCH TO PAYING. SO NO FREE LUNCH. AND THERE WAS ABOUT 5,000 STUDENTS. AND THERE WERE SOME SCHOOLS THAT I LOOKED ON THERE AND I'M LIKE, WHY IS IT SO HIGH? IT WAS A LITTLE DIFFERENT. SO WE'RE GOING TO USE THAT TO TARGET THOSE SCHOOLS, THOSE NEIGHBORHOODS AND BE ABLE TO LOOK WHO THOSE FAMILIES ARE TO BE ABLE TO ENROLL THEM IN MEDICAID IF THEY ARE NOT ENROLLED OR SOME TYPE OF INSURANCE. Jessica Vaughn: INSTEAD OF USING A LIST, WE WOULD BE LOOKING MORE FROM THE STUDENT NUTRITION TO IDENTIFY FAMILIES. Jamie Lewis: RIGHT. THAT WOULD GIVE US
063THE MOST REAL-TIME INFORMATION, WHEREAS -- BECAUSE THEY ARE ALREADY APPLYING IN THOSE REGARDS FOR SOME OF THE SAME TYPE OF LEVELS THAT WE WOULD BE LOOKING FOR FOR MEDICAID. Jessica Vaughn: I HAVE TWO MORE QUESTIONS. I APPRECIATE IT. I KNOW I HAVE A LOT OF QUESTIONS. I HEARD YOU MENTION THE NUMBER $200 MILLION IS MAYBE JUST A GUESSTIMATE DEPENDING ON WHAT THE REIMBURSEMENT RATE LOOKED LIKE AND THE NEW SCHEDULE, SAFETY SCHEDULE, FOR LACK OF A BETTER WORD, EVEN THOUGH I KNOW WE'RE MOVING AWAY FROM THAT. THAT'S STATEWIDE $200 MILLION IS WHAT YOU'RE TALKING ABOUT, RIGHT? YES. Jessica Vaughn: IS THERE A WAY IN OUR FEE SCHEDULE STUDY THAT WE COULD FIGURE OUT -- I'M SURE THAT'S WHAT THE POINT OF THE STUDY IS GOING TO BE, WHAT THE DIFFERENCE COUNTYWIDE WOULD BE, THAT'S PART OF
064THE FEE SCHEDULE. SO WE'VE ALREADY DETERMINED -- WE, MEANING THE DEPARTMENT OF EDUCATION HAS TAKEN OUR CLAIMS FOR THE LAST COUPLE OF YEARS AND ALREADY DETERMINED HOW MUCH VERY LARGE, LARGE, MEDIUM DISTRICTS ARE LOSING OR WILL GET LATER DEPENDING ON YOUR PERSPECTIVE. SO IT'S ABOUT $10 MILLION FOR VERY LARGE DISTRICTS. Jessica Vaughn: THANK YOU. I APPRECIATE YOU POINTING THAT OUT. YOU'RE WELCOME. Jamie Lewis: LOSING ABOUT HALF OF WHAT WE ARE SUPPOSED TO BE GETTING. Jessica Vaughn: MY FINAL QUESTION KIND OF GOES ALONG WITH MEMBER GRAY. SHE WAS TAKING IN A REDUCTION OF MEDICARE HOW WOULD THAT AFFECT US? I KNOW YOU SAID WE'RE HOPING FOR AN INCREASE IN THE FEE SCHEDULE. I THINK MY QUESTION IS, IF THERE IS A REDUCTION IN ACCESS AT THE STATE LEVEL, MEANING WHATEVER IT IS FOR KIDS TO QUALIFY
065OR FAMILIES TO QUALIFY CHANGES, AND THERE IS A REDUCTION IN ACCESS LEVEL, THAT THEN WOULD HAVE AN EFFECT ON OUR COUNTY AS WELL IN THE SAME WAY AS MAYBE THE FEE SCHEDULE CHANGING, BUT IF LESS FAMILIES HAVE ACCESS TO MEDICAID, THAT ALSO IMPACTS US BECAUSE YOU'RE SAYING WE'RE GOING TO PROVIDE THESE SERVICES ANYWAY, BUT THE FAMILIES WON'T HAVE THE COVERAGE FOR US TO GET ANYTHING BACK, IS THAT CORRECT? IT'S A POSSIBILITY, BUT WE'LL DO WHAT WE CAN TO ENROLL THESE STUDENTS THAT HAVE LOST COVERAGE. BUT THERE ARE STUDENTS ENROLLED NOW THAT ARE RECEIVING SERVICES. Jessica Vaughn: CHANGING THE ACCESS, LESS KIDS HAVING ACCESS WILL HURT US BECAUSE AGAIN WE'LL STILL OFFER THE SERVICES. Jamie Lewis: YES, POTENTIALLY LESS STUDENTS INVOLVED IN THE REIMBURSEMENT PORTION. THE STUDENTS WOULD STILL RECEIVE THE SERVICES, BUT WE HAVE LESS
066KIDS TO GET REIMBURSED FROM. Jessica Vaughn: THANK YOU. I APPRECIATE THIS. I KNOW I ASKED A LOT OF QUESTIONS. THANK YOU. MEMBER PEREZ. Karen Perez: DURING THAT TIME, WE HAD A LOT OF FAMILIES THAT MOVED AND DIDN'T RECEIVE THEIR LETTERS TO REAPPLY. SO THEY GOT BOOTED OFF THE SYSTEM, AM I CORRECT? YES, THAT'S CORRECT. ADDRESSES ARE WRONG AND THINGS LIKE THAT, YES. Jamie Lewis: ANOTHER IMPORTANT NOTE IS THE STATE OF FLORIDA HAS CHANGED THE MINIMUM WAGE OVER THE LAST COUPLE OF YEARS AND IS IN THE FINAL YEARS OF THAT. SO THAT CHANGES THINGS, TOO, AS WE SEE THE BASE OF PAY IN FLORIDA MOVE UP A DOLLAR PER YEAR, THAT OBVIOUSLY IMPACTS FAMILIES AND THAT ALSO COULD BE A FACTOR IN WHY SOME OF THE NUMBERS HAVE CHANGED. Karen Perez: SUPERINTENDENT, IS THERE A POSSIBILITY
067THAT WE COULD PROBABLY PUT A WIDGET ON OUR WEBSITE WHERE THE FAMILIES COULD GO ON THERE, MAYBE A LINK TO THE MEDICAID APPLICATION PROCESS? Van Ayres: THAT IS AN ABSOLUTE POSSIBILITY TO DO THAT. WORK WITH MS. ARJA, ESPECIALLY MOVING TO OUR NEW WEBSITE SYSTEM, TRANSFERRING THAT OVER NOW. THAT WOULD BE AN EASY THING TO DO FOR US. Karen Perez: FAMILIES LOOKING TO APPLY FOR HILLSBOROUGH COUNTY SCHOOLS OR JUST LOOKING THROUGH OUR WEBSITE COULD PROBABLY ACCESS THAT. OUR REIMBURSEMENT RATE IS HOW MUCH RIGHT NOW? SO IT DEPENDS. SO WE GET REIMBURSED FOR PSYCH EVALS. REIMBURSED FOR COUNSELING. WE GET REIMBURSED FOR NURSING. THEY ARE ALL DIFFERENT RATES. Karen Perez: WHAT IS THE HIGHEST RIGHT NOW? FOR EVALUATIONS, WE GET MAYBE $48.50 PER EVALUATION. I DON'T EVEN WANT TO SAY THIS OUT LOUD BECAUSE THE PROVIDERS WILL
068BE NOT WANTING TO DOCUMENT. IT'S NOT WHAT WE SHOULD BE GETTING. IT'S A LOT LESS THAN WE SHOULD BE GETTING. Karen Perez: 1998 RATE? YEAH. IT'S ABOUT THAT. Karen Perez: '97. IF SENDING OUR AMAZING KRISTIN AND WITH US SPEAKING TO THE LOBBYISTS AND GOING UP TO TALLAHASSEE AND EDUCATING OUR LEGISLATORS, OUR SENATORS, OUR CONGRESSMEN AND WOMEN, WE WOULD MOVE THAT UP TO WHAT IS THE RATE THAT IT SHOULD BE TODAY? SO IT'S NOT SO MUCH WHAT IS THE RATE. IT'S HOW THEY REIMBURSE US. HOSPITALS, DOCTORS' OFFICES, WHEN IT COMES TO MEDICAID, YOU'RE NOT ALLOWED TO MAKE A PROFIT. YOU CAN ONLY COVER YOUR EXPENSES. AND THAT IS THE SAME THING WITHIN THE SCHOOL DISTRICT. YOU CAN COVER YOUR EXPENSES. OUR EXPENSES ARE MUCH GREATER THAN THE $6 MILLION THAT WE GOT REIMBURSED LAST YEAR. SO
069THAT'S REALLY THE CONVERSATION TO HAVE IS THAT WE NEED TO BE PAID BASED ON WHAT OUR COSTS ARE, NOT BASED ON A 1997 FEE SCHEDULE. Karen Perez: WHICH, SUPERINTENDENT, IS MUCH BETTER THAN IT WAS. THE LAST TIME WE HAD THIS WORKSHOP, WE ONLY HAD A REIMBURSEMENT RATE OF 2 MILLION. I SEE, HOW MUCH IS REIMBURSED. Karen Perez: AT LEAST SIX. SO WE'RE MAKING GAINS. BECAUSE WE'RE BRINGING AN AWARENESS, AND THANK YOU SO MUCH FOR THIS WORKSHOP AND THE AWARENESS THAT YOU'RE BRINGING AND HOW MUCH IT'S REALLY IMPACTING OUR STUDENTS AND THE SERVICES THAT WE BRING TO THE TABLE FOR THEM. BECAUSE BEING ABLE TO. BUT MY THING IS, WHEN YOU'RE LOOKING AT THOSE FIVE STATES, FLORIDA BEING NUMBER ONE ON THERE, CAN WE MIMIC SOMETHING THAT THE OTHER STATES, LIKE YOU MENTIONED, ARE DOING DIFFERENTLY,
070THAT WE COULD POSSIBLY DO ON OUR END TODAY THAT WOULD MAYBE TURN THIS AROUND FOR US? OR IS IT AT A STATE LEVEL, THE ONLY WAY WE COULD CHANGE THIS? IT IS AT THE STATE LEVEL. THAT IS THE ONLY WAY IT COULD BE CHANGED. HOWEVER, WE HAVE MET WITH THOSE OTHER STATES, LIKE I SAID, AND SO IS AHCA, BELIEVE IT OR NOT. THEY HAVE FINALLY COME TO ONE OF THE NATIONAL MEETINGS AND THEY HAVE MET WITH MICHIGAN. THE PERSON AT MICHIGAN WHO RUNS THE PROGRAM THERE AND COST RECONCILIATION. SO THEY CAN CREATE A SPA, SO THEY CAN LEARN ABOUT IT. THEY HAVE DONE THE WORK. I DON'T KNOW WHAT HAPPENED, WHERE THEY ARE, WHY WE JUST CAME TO A STAND-STILL. I THINK THAT'S WHY YOU SEE OTHER DISTRICTS IN THE STATE OF FLORIDA AND THESE
071OTHER STATES, WHAT THEY HAVE DONE IS THE ONLY LEVERAGE AND CHANGE WE CAN CONTROL IS A RATE STUDY. SO WE'LL DO THAT FOR OUR SERVICES AND PROVIDE THAT. LEVY COUNTY DID ONE FOR TRANSPORTATION. VERY SUCCESSFUL IN IT. SHE HAS EXPERIENCE DOING THE SAME THING AT HER PREVIOUS DISTRICT. WE BELIEVE THAT IS THE STOPGAP THAT WE CAN DO, THAT WE CAN GET OUR RATES AT LEAST SOMEWHAT RIGHT-SIDED FROM THE 1997 SCALE. THINGS HAVE CHANGED A LOT IN THAT TIME PERIOD. SO WE'RE GOING TO WORK ON THAT. JUST TO MAKE YOU AWARE, THAT DOES TAKE A LITTLE BIT OF TIME. THAT ISN'T SOMETHING WE CAN DO OVERNIGHT. WE ALREADY STARTED PLANNING FOR THAT. WE'LL ATTACK THAT VERY AGGRESSIVELY. IT DOES TAKE TIME AND WILL TAKE TIME FOR THAT TO SHOW AN IMPACT. I DON'T KNOW IF THIS
072NEXT FISCAL YEAR WE'LL GET ALL OF THAT DONE WHERE WE CAN SEE A SIGNIFICANT GROWTH RATE, BUT THERE IS A PROCESS THAT WILL BEGIN BECAUSE WE STILL HAVE TO FILE THE DOCUMENTATION WITH THE CERTAIN DIFFERENT PLACES TO SHOW THE RATE STUDY AND HOW WE CAME TO THE RATES AND GET APPROVED. Karen Perez: THE MENTAL HEALTH NEED OF OUR STUDENTS IN OUR DISTRICT HAS CHANGED DRASTICALLY AND PROVIDING THOSE SERVICES TO THEM REALLY HAS -- IT'S JUST -- WILL YOU LET ALL THE BOARD MEMBERS KNOW WHEN THE RATE STUDY IS GOING TO START SO WE CAN KEEP AN EYE ON THIS, PLEASE? IT WILL START PROBABLY NEXT WEEK. Jamie Lewis: WE ALREADY IDENTIFIED THE POTENTIAL OF WHEN WE WANT TO START. WE HAVEN'T FINALIZED OUR PROCESS FOR THAT. BUT WE WILL BEGIN IMMEDIATELY NEXT WEEK WITH AT
073LEAST SELECTING THE FIRST ONE AND GOING AFTER THAT, AND CONTINUE WORKING THROUGH A PRIORITY LIST. Karen Perez: FABULOUS. COULD YOU LET US KNOW IF IT MAKES A DIFFERENCE? ABSOLUTELY. Jessica Vaughn: THANK YOU, MEMBER PEREZ. MEMBER GRAY. Lynn Gray: THANK YOU, MADAM CHAIR. I APPRECIATE THE BOARD'S COMMENTS VERY, VERY MUCH, ESPECIALLY AS IT RELATES TO WHAT CAN WE DO AS BOARD MEMBERS TO GET TO OUR LOBBYISTS AND TO GET TO OUR LEGISLATIVE FOLKS AND THEIR EDUCATION ALSO WITH WHAT YOU'RE GIVING NEEDS TO BE EQUAL. THOSE DISCUSSIONS WILL PROBABLY HELP GREATLY. MY ARGUMENT OR MY DILEMMA, THIS IS AS AN INDIVIDUAL SCHOOL BOARD MEMBER, IN LOOKING AT POSSIBLE REDUCTIONS AND THE IMPACT THOSE REDUCTIONS OF MEDICAID WILL HAVE, I WOULD LIKE MR. LEWIS, IF YOU COULD GO AHEAD AND GIVE A PERCENTAGE -- I GAINED THESE PERCENTAGES
074FROM ANOTHER DISTRICT. THERE ARE SEVERAL CATEGORIES. MEMBER PEREZ, YOU MENTIONED MENTAL HEALTH SERVICES. THAT'S GOING TO ALSO IMPACT. IT'S GOING TO IMPACT SPECIALIZED ESE INSTRUCTORS. IT'S GOING TO IMPACT PHYSICAL HEALTH SERVICES. IT'S GOING TO IMPACT PREVENTION AND EARLY INTERVENTION SERVICES. IT'S GOING TO IMPACT THE ACTUAL REFERRAL SERVICES FROM THE CARE COORDINATORS. IT'S GOING TO IMPACT THE MEDICAID OUTREACH AND ENROLLMENT SERVICES. IT'S GOING TO IMPACT STUDENT RESOURCES, TECHNOLOGY, EQUIPMENT, AND TRANSPORTATION. I THINK THAT'S GOING TO BE IMPORTANT. NOW, IDEALLY, WE'RE NOT GOING TO SEE ANY DIFFERENCE OR MAYBE WE'LL HAVE MORE MONEY. THAT'S NOT THE REALITY I'M READING AND NOT THE REALITY THAT OTHER SCHOOL DISTRICTS ARE LOOKING AT. THEY ARE LOOKING AT A DECREASE. WITH THE SPA AND ALL THE GREAT INTENTIONS THAT WE HAVE, I THINK THE REALITY IS WE NEED TO BE PREPARED
075FOR AN IMPACT OF REDUCTION BECAUSE WE CANNOT BE BLIND TO WHAT PROBABLY WE'LL BE READING IN THE NEWSPAPER QUITE SHORTLY. THERE ARE BUDGETARY SITUATIONS GOING ON THAT WILL REVEAL A DECREASE IN THE MEDICAID DEPARTMENT, ASIDE FROM WHAT YOU'RE ALREADY SHARING. THAT'S MY ASK. ONE CURIOUS QUESTION, HOW DO CHARTER SCHOOLS, HOW DOES IT INTERFACE WITH CHARTER SCHOOLS IN TERMS OF THE MEDICAID? CHARTER SCHOOLS HAVE BEEN ABLE TO USE THE SCHOOL DISTRICTS IN THE CAN OF THE THAT THEY ARE IN. SO THE CHARTER SCHOOLS IN HILLSBOROUGH COUNTY COULD USE OUR MEDICAID PROVIDER ID AND USE OUR SYSTEM AND PROVIDE SERVICES TO STUDENTS AND SUBMIT CLAIMS. AND THAT WOULD BE WITH AN AGREEMENT WITH THE SCHOOL DISTRICT. CURRENTLY, THE STATE OF FLORIDA DOES NOT HAVE ANY SCHOOL DISTRICTS THAT ALLOW THE CHARTER SCHOOLS TO USE THEIR PROVIDER ID
076NUMBER. WE HAVE A FEW CHARTER SCHOOLS THAT RECENTLY SINCE 2020, WHEN THEY ADDED THE -- THE GOVERNOR ADDED CHARTER SCHOOLS AND PRIVATE SCHOOLS ON, WE NOW HAVE PROBABLY FIVE OR SIX CHARTER SCHOOLS THAT GOT THEMSELVES ENROLLED. THEY HAVE THEIR OWN PROVIDER NUMBER AND THEY BILL MEDICAID ON THEIR OWN. EVERYONE IS STARTING TO BUILD UP THE INFRASTRUCTURE TO BE ABLE TO DO IT. Lynn Gray: THAT IS A GOOD THING. YES, IT'S A GOOD THING. Lynn Gray: THE FOLLOW-UP QUESTION, TOO, WHEN WE TALK ABOUT SELF INSURANCE, AETNA, FOR EXAMPLE, HOW DOES MEDICAID INTERFACE WITH OUR SELF-INSURED STATUS? ANYTHING AT ALL? Jamie Lewis: NO RELATION. Lynn Gray: NO RELATIONSHIP AT ALL. THANK YOU, MADAM CHAIR. Jessica Vaughn: THANK YOU, MEMBER GRAY. DR. HAHN. Stacy Hahn: THANK YOU. I KNOW WE ALL WANT TO TRY AND PREDICT WHAT'S GOING
077TO HAPPEN TO MEDICAID OR MEDICARE IN THE FUTURE, BUT LET'S NOT FORGET IN 2023, MILLIONS OF FAMILIES LOST THEIR MEDICARE COVERAGE. IT'S BEEN AN ONGOING PROBLEM REGARDLESS OF THE ADMINISTRATION. IT'S NOT BEEN FUNDED TO ITS POTENTIAL. SO WITH CHILDREN THAT ARE IN THE CHIP PROGRAM, DO WE GET ANY REIMBURSEMENT FOR THAT? CURRENTLY WE DO NOT. HOWEVER IN THE MAY 2023 FEDERAL GUIDE THAT CAME OUT IT SAYS THAT WE CAN GET REIMBURSED. SO HOPEFULLY THEY ARE GOING TO IMPLEMENT THAT. THERE ARE STILL SOME ISSUES WITH CHIP. I HAVE ASKED THAT A LOT OF TIMES. WE DON'T CHECK ELIGIBILITY FOR ANY CHIP STUDENTS. SO THAT'S WHERE IT WOULD HAVE TO START. AND THEY ARE NOT REALLY TALKING ABOUT -- THEY DON'T WANT TO GROW THE PROGRAM, THE AGENCY FOR HEALTH CARE ADMINISTRATION, BECAUSE THAT WOULD MEAN MORE
078WORK FOR THEM AND MAKE IT MORE COMPLEX. BUT THE FEDERAL GUIDE SAYS WE CAN. Stacy Hahn: BECAUSE THE CHILDREN IN THE CHIP PROGRAM, THEY MAKE MORE -- THEY MAKE TOO MUCH MONEY FOR THE MEDICAID PROGRAM, CORRECT? YES, THAT'S CORRECT. Stacy Hahn: I KNOW THAT WE TRY AND ENROLL AS MANY STUDENTS AS POSSIBLE, BUT WHEN CHILDREN ARE BEING DISCHARGED FROM HOSPITALS AT BIRTH WHO HAVE HIGH MEDICAL COMPLICATIONS, THEY ARE BEING ENROLLED AT THAT POINT IN TIME ALSO IN MEDICAID. BY HOSPITALS, YES. Stacy Hahn: I WORKED IN A NICU FOR YEARS. I REMEMBER DOING THAT -- NOT ME ENROLLING THEM, BUT I REMEMBER THAT BEING PART OF THE DISCHARGE PROCESS. AND THEN ALSO, FIDDLER, SCREENING KIDS, WOULD THERE BE A TOUCH POINT TO ENROLLMENT? ABSOLUTELY. I'M WORKING WITH STEPHANIE FRIEDMAN OVER THERE. SHE'S AMAZING, AND SHE'S ALL
079ON BOARD, YES. Stacy Hahn: OBVIOUSLY, WHEN STUDENTS COME TO US AND THEY ARE IDENTIFIED FOR ESE PROGRAMMING, THEN THAT'S WHEN WE STEP IN. I WOULD IMAGINE DURING IEP MEETINGS, ESPECIALLY INITIAL ONE, WE ARE ENCOURAGING PARENTS TO ENROLL. OBVIOUSLY, WE CAN'T FORCE THEM TO, BUT THEY WOULD -- WE WOULD BE ENCOURAGING THAT. WE WOULD PROVIDE INFORMATION DURING THAT TOUCH POINT. I APPRECIATE THE ACTION STEPS. I THINK HOPEFULLY WHEN WE TALKED ABOUT OUR LEGISLATIVE PLATFORM FOR NEXT YEAR, WHICH WE SHOULD PROBABLY BE TALKING ABOUT VERY SOON, EVEN THOUGH SESSION IS STILL GOING ON, THAT WE WOULD WANT TO INCLUDE THIS IN OUR PLATFORM AND KIND OF GALVANIZE MANY OTHER DISTRICTS THROUGH YOUR POINTS OF CONTACT TO GET THEM TO ALSO PUT IT ON THEIR PLATFORMS AND THEN PERHAPS THROUGH THE SUPERINTENDENT AND HIS SUPERINTENDENT CONFERENCES THAT HE
080ATTENDS, PERHAPS TRYING TO SET UP A MEETING OF SUPERINTENDENTS TO DISCUSS THIS, MAYBE ONE OF YOU GOING WITH HIM, WHETHER IT IS HAVING A LUNCH WITH THEM, BUT TRYING TO GALVANIZE AS MANY FLORIDA SUPERINTENDENTS AS POSSIBLE AROUND THIS ISSUE. SO I THINK THERE'S MANY OF US THAT HAVE TO WALK AWAY TODAY WITH ACTION STEPS. TO REALLY GET ENOUGH PEOPLE AROUND THIS ISSUE FROM DIFFERENT POINTS OF THE EDUCATION ARENA. THANK YOU. THANK YOU FOR ALL THE INFORMATION. AND THE WAY YOU PRESENTED IT, BECAUSE I DIDN'T KNOW A LOT ABOUT IT. I KNEW VERY LITTLE AND I FEEL LIKE I LEARNED A LOT, KIND OF HOW YOU DUMBED IT DOWN FOR US. Jamie Lewis: MS. DINEEN DOES A GREAT JOB FOR US. STAFF AND FINANCE DEPARTMENT WORKING VERY HARD AT THIS AND VERY PASSIONATE AS YOU CAN
081SEE AND EXCITED FOR THE OPPORTUNITIES WE HAVE BEFORE US. Jessica Vaughn: I APPRECIATE ALL OF MY FELLOW BOARD MEMBERS' COMMENTS. I FEEL LIKE TODAY WAS A REALLY GOOD DISCUSSION. I HAVE THREE QUICK QUESTIONS. HOW LONG -- I KNOW YOU SAID THIS STUDY YOU ANTICIPATE IT BEING A LENGTHY ONE. WHAT IS THE TIMELINE? OBVIOUSLY IT'S NOT A HARD AND FAST ONE, BUT THE GENERAL TIMELINE THAT YOU'RE ANTICIPATING? I WOULD THINK FROM PROBABLY THREE MONTHS. BY THE TIME WE GET THE COMMITTEE TOGETHER, WE GET THE DATA TOGETHER, WE HAVE TO DETERMINE WHAT DATA WE NEED. WE HAVE TO DETERMINE THE RIGHT PEOPLE THAT SHOULD BE THERE, PULL THE REPORTS AND THEN WE HAVE TO PULL IT ALL TOGETHER. IT HAS TO GET SENT TO -- GUESS WHO -- AHCA TO GET APPROVED. SO HOW LONG IT TAKES
082FOR THEM TO APPROVE IT, I'M NOT SURE. Jessica Vaughn: THREE MONTHS IS OPTIMISTIC? Jamie Lewis: YES. I WOULD SAY DIFFERENT RATES, DIFFERENT STUDIES, DIFFERENT TIMELINES. TRANSPORTATION WILL PROBABLY BE ONE OF OUR BIGGEST OPPORTUNITIES, BUT ALSO TAKE MOST TIME OUT OF A LOT OF OTHER STUDIES. Jessica Vaughn: ALSO SEGMENTED BY DIFFERENT -- Jamie Lewis: WE'LL BE WORKING ON MULTIPLE STUDIES AT THE SAME TIME. Jessica Vaughn: THAT'S HELPFUL. ONE OF THE OTHER QUESTIONS I HAD, I KNOW THAT MEMBER PEREZ WAS TRYING TO GET AN IDEA OF THE DIFFERENCE IN FEES INDIVIDUALLY. WE USED AN EVALUATION AS AN EXAMPLE OF MAYBE GETTING $46 REIMBURSEMENT. BUT I THINK THE QUESTION IS, IF -- I MEAN, GETTING ON THE FEE SCHEDULE. IF IT WAS A FULL REIMBURSEMENT, HOW MUCH DOES IT COST TO DO ONE OF THOSE TO COMPARE THOSE
083TWO? HOW MUCH DOES IT COST -- I'M SORRY, A RATE STUDY? Jessica Vaughn: NO. FOR THE EVALUATION. OH, I SEE WHAT YOU'RE SAYING. Jessica Vaughn: YOU SAID WE GOT ABOUT $46. IF WE'RE GETTING HUNDRED PERCENT REIMBURSEMENT, WHAT WOULD THAT LOOK LIKE COMPARED TO THE $46? THAT'S WHAT WE HAVE TO DETERMINE. Jessica Vaughn: WE'RE NOT SURE YET. NO, I DON'T KNOW YET. Jamie Lewis: WE CAN PROVIDE FEEDBACK TO THE BOARD AS WE GO THROUGH THE PROCESS TO SHOW WHAT OUR STUDY DETERMINED AND THE OUTCOME. YES. Jessica Vaughn: AND THEN MY FINAL QUESTION, AS WE TALKED ABOUT CHARTER SCHOOLS, THANKS FOR BRINGING THAT UP, FOR THE EVALUATIONS THAT WE DO FOR CHARTER SCHOOLS, ARE WE USING OUR ID NUMBER FOR THAT? OUR MEDICAID ID NUMBER? YES. Jessica Vaughn: SO WE ARE GETTING REIMBURSEMENTS FOR CHARTER SCHOOLS IF
084WE DO THE EVALUATION BECAUSE WE'RE PROVIDING OUR MEDICAID ID NUMBER. YES. WE DO THAT. OTHER DISTRICTS MAY NOT, BUT SINCE WE HAVE THE EXPENSE, THEN WE GET TO CLAIM THAT SERVICE. THAT'S HOW WE LOOK AT IT, SO, YES. Jessica Vaughn: THAT'S HELPFUL. I DON'T HAVE ANY OTHER QUESTIONS. I THINK, BOARD MEMBERS, ARE WE GOOD? SEEING THAT, THIS WORKSHOP IS ADJOURNED. THANK YOU.