State to Change School Medi-Cal Billing Program

We have very exciting news to share about the “free care rule” reversal that reopens a critical avenue of reimbursement for Local Education Agency (LEA) school health providers.

Learn More About the Free Care Rule

The Department of Health Care Services (DHCS) announced on August 29 that changes to the provider manual for the LEA Billing Option Program will reflect the most recent policy direction from the Centers for Medicare & Medicaid Services (CMS) regarding “free care.” The draft changes to the manual are available for review and should be officially published later in September.

This exciting anticipated change to the LEA Billing Option program ensures that Medi-Cal may reimburse LEA providers for services provided to Medi-Cal eligible students, even if they are not in special education.

We hope that everyone providing health services in schools will learn about this opportunity to draw down more revenue to create robust school health systems that include both school districts and community providers.

You can learn more about the “free care” policy, the LEA Billing Option program, and CMS’s policy change on our Free Care Rule page. We have been working closely with DHCS, LEAs, the California School Nurses Organization, and other advocates to make sure that our state makes changes to the LEA program to strengthen school-based health care.