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Community-Driven School Health Planning: Colorado's MESH Program Challenges and Outcomes

Explore the challenges and outcomes of Colorado's School-Based Medicaid Claiming Program, focusing on community-driven health planning, funding complexities, and conflicting regulations. Learn about the MESH Program structure, funding flow, revenue stream, spending requirements, and navigating complexities.

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Community-Driven School Health Planning: Colorado's MESH Program Challenges and Outcomes

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  1. Community Driven School Health PlanningChallenges and Outcomes in Colorado’s School-Based Medicaid Claiming Program

  2. MESH Program Creation • 1997 – Colorado Legislation CRS 26-4-531 • Medicaid revenue would be used to expand preventive and primary health care services for public school children.

  3. MESH Program Structure • Claiming (HCPF) • Bill Medicaid for medical services that are delivered to Medicaid clients in school setting • Local Services Plans (CDE) • Community-driven plan for delivery of health services to general student population • Generalized health services are funded by Medicaid reimbursement dollars

  4. Challenges • Compliance with regulations • Revenue Generation vs. Revenue Spending • Lack of understanding • Lack of direction from CDE

  5. MESH Funding Flow CMS (Federal $) State (HCPF) (State $) Federal Grant Contract Federal Law Medicaid Rules Federal Medicaid Law State Purchasing Contract State Purchasing Law Regulating Authority Service to Medicaid Client (District $) LSP Services to all students (District $)

  6. Layers of Regulation • Federal Medicaid Law • CMS Guidelines • State Plan (CMS Contract) • State Purchasing Law • State Statute Authorizing Program • Department Rules • Program Guidelines

  7. Conflicting Intents • Federal Law • To allow districts to recover some costs associated with unfunded IDEA mandates • State Law • No supplanting clause precludes districts from spending reimbursement funds on mandated services

  8. Revenue Stream • Revenue generation – Federal level requirements (State Plan) • Revenue Spending – State level requirements

  9. Spending Requirements • No supplanting - No spending on mandated services • Local Services Plans - Community driven health planning

  10. Navigating the Complexities • Contradictory Requirements • Conflicting Systems • Coordination Between Departments • Lack of Definition • Delay of CMS Guidelines - audit exceptions interpreted as policy change • Medical vs. Health Service

  11. MESH Planning Steps (LSP) • Health Needs Assessment/Targeted Assessment • Gather Community Input • Organize Data • Make Decisions (prioritize needs) • Develop Program Plan

  12. Community Involvement Community Based Organization Community Center Board Community Members Group Home and Foster Care Health Care Providers Homeless Liaisons Law Enforcement Local Government Mental Health Providers Migrant Programs Parents Probation and Parole Officers Public Health Public Housing Programs Refugee Programs Religious Organizations School Based Clinics School Board School District Staff School-to Work Programs Social Services, Students Special Education Staff/ Providers Teachers Teen Parenting Programs Transition Programs Treatment Programs

  13. Competing Priorities

  14. [1] Some districts did not report Occupational and Physical Therapy as separate categories.

  15. Types of Service

  16. Contact Information Barbara Ramsey Colorado Department of Health Care Policy and Finance 1570 Grant St Denver, Co 80203 303-866-2430 barbara.ramsey@state.co.us Michelle Farrell Colorado Department of Education 201 E Colfax Ave Denver, CO 80203 303-866-6978 farrell_m@cde.state.co.us

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