BISD renews Medicaid Administrative Claiming contract as SHARS changes squeeze reimbursements; Houston consultants offer legal and program support
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Summary
Trustees approved a renewal to continue participation in Medicaid Administrative Claiming (MAC). District and outside advisors described major SHARS changes that reduced reimbursements statewide and urged stricter documentation and participant-list reviews.
The Brownsville Independent School District board approved a multi-year renewal on May 6 to continue the district’s participation in Medicaid Administrative Claiming (MAC) and related services used to recover Medicaid-related administrative costs.
Mary Garza, the district’s finance representative, presented the item and said the district’s annual MAC-related reimbursements typically vary and have recently been in the neighborhood of $200,000–$280,000 a year depending on participant lists and compliance. Trustees asked how training and random moment time-study (RMTS) compliance are being handled; Garza said training for administrative leads is provided by the district’s vendor and that campus participants receive training and reminders to meet the program’s response windows.
Representatives from Houston ISD’s Medicaid finance team — including Crystal Forsky and Michael Acosta — joined the meeting to explain why many Texas districts have seen sharp declines in SHARS (School Health and Related Services) and related cost-report revenue. Forsky said recent Texas Administrative Code (TAC) guidance and state HHS enforcement have narrowed what constitutes billable personal-care and transportation services and tightened paid-claim requirements; she said many districts have seen program revenue drops and that a legal challenge over the 2022 cost report has moved toward federal court. “Districts have lost over 50% of the revenue,” she said in describing statewide effects, and she urged districts to review participant lists and documentation to maximize allowed claims.
Trustees and staff discussed whether outside SHARS contractors should assist with cost-report compilation going forward; Garza said staff would pursue collaboration with the vendor and external partners to ensure documentation and to try to maximize reimbursements. Board members thanked the outside consultants for offering to provide a district workshop on SHARS/MAC program health and compliance.
Why it matters: MAC and SHARS reimbursements provide district General Fund relief for some services associated with special education and health services. Changes in state rules and enforcement have reduced some districts’ recoverable revenue and increased the administrative burden for accurate documentation and training.
What’s next: The board approved renewal of the MAC partnership and asked administration to coordinate training, review participant lists and return with recommended process improvements and any options for outside-assistance on cost reports.