In November of 2023, California governor Gavin Newsom signed Assembly Bill AB 483, paving the way for California schools to take part more easily in California’s Local Education Agency Billing Option Program (LEA BOP). The primary goal of AB 483 is to enhance the accessibility of federal Medicaid reimbursement funds for school-based mental health and health services provided to Medi-Cal students. 

California Schools Have Been Reluctant to Use Medi-Cal Billing  

According to the CA Assembly AB 483 Fact Sheet, the “current Medi-Cal LEA BOP is administratively burdensome, due to extensive documentation requirements, and punitive audit practices.” In the past, California schools have struggled with Medi-Cal audit practices and have even had to return significant amounts of funds if they were disallowed during audits. Many LEAs have also received unclear and inconsistent guidance from the state around  Medi-Cal billing leading many of them to opt out of the program. 

In fact, it’s easy to see why LEAs are reticent to take advantage of Medi-Cal billing options when data from the Department of Health Care Services (DHCS) showed that 75% of LEA provider claims audited between 2007 and 2015 required some level of repayment to the state.  

In a recent survey, it was also noted that auditors in other states take on a more supportive role, while California’s auditors have been more compliance focused and punitive. Because of this, many LEAs have stopped participating in the LEA BOP to avoid dealing with burdensome audit requirements, unrealistic timelines, and excessive documentation demands. 

According to a press release from AB 483’s author, Assemblymember Al Muratsuchi,  

 AB 483 Aims to Reform Medi-Cal Billing in California Schools 

AB 483 is designed to expand access to school-based mental health and health services by making it easier for schools to participate in Medi-Cal billing through the LEA BOP, thereby increasing funding to support students in California schools. According to the AB 483 Fact Sheet, the auditing process will be reformed by DHCS, changing the way Medi-Cal claims from LEA BOP are handled. The goal of AB 483 will be to ensure: 

• Schools are reimbursed for all eligible services not precluded by federal law 
• All audits are completed, and the LEA is notified of the findings, within 12 months of claims being made  
• A final settlement of audits is performed, including completion of appeals, within 3 years 
• Technical help is provided to LEAs and they will be assisted with corrective action plans if more than 25% of claims must be repaid 
• Expedited appeals of audits requiring repayment of more than 50% of an LEAs total claims 
• Key stakeholders are involved in the formulation of any state plan amendments needed to implement these provisions 
  
• Annual reports on the number of LEA BOP audits completed, the amount of funds disallowed, and any technical aid provided to LEAs 

Hope for the Future of Medi-Cal Billing and Funding for School-Based Mental Health Services 

For many school districts across California, the announcement of Governor Newsom’s signing of AB 483 was welcome news. While many details have yet to be released, there is significant hope among those in education that California schools may have better access to Medicaid funds through Medi-Cal billing in the very near future.  

Assemblymember Muratsuchi's words are surely music to the ears of anyone overseeing the tight budgets of school-based mental health services departments. Additionally, the average school psychologist, school counselor, or school social worker scraping by with an overburdened caseload may be heartened to hear that both Los Angeles Unified School District (LAUSD) and the California Association of School Psychologists (CASP) were co-sponsors of AB 483. The LAUSD Superintendent recently had this to say about AB 483:  

Both LAUSD and CASP are very aware of the current need for more funding of school-based mental health services and are looking forward to AB 483 helping more students and families access services at local school sites. Hear what the President of CASP has to say about AB 483: 

Exym EHR Software is Already Set-Up for CalAIM Billing and Used by California Schools 

In recent years, school districts have faced unprecedented challenges in meeting the social, emotional, and behavioral needs of their students. Many California schools have had to quickly expand existing programs and build entirely new school-based mental health services as they adapt to the changing needs of students. On top of that, districts often must hire and train new personnel, figure out new systems of documentation and data tracking, supervise counseling or social work interns, and try to figure out how to submit billing claims.  

To complicate matters, in 2022 California began the CalAIM Initiative, a multi-year process to transform Medi-Cal into a more coordinated, person-centered, and equitable health system. Essentially, by the year 2027, Medi-Cal will become CalAIM, and in the process a new system of billing requirements is being put into practice.

This is where Exym has stepped in to champion California schools and social service agencies as they work to support growing behavioral and mental health needs while navigating CalAIM billing requirements. Exym EHR Software was built with California agencies in mind, and we've been busy developing and implementing CalAIM billing functionality to keep our customers up-to-date with CalAIM requirements. We are proud to say that Exym has never missed a compliance deadline!

Exym Partners with California Schools to Streamline Documentation and CalAIM Compliance

Exym is the trusted choice for California schools when it comes to confidential documentation and safeguarding student data privacy. Multiple districts in Southern California have also partnered with Exym to effectively manage private insurance, LADMH, and CalAIM billing claims.

Hear what Upland Unified School District has to say about the Exym features their Counseling Center interns love most and how Exym is helping to simplify their documentation processes: 

At Exym we understand how overwhelming it can be to learn new software and figure out billing claims, and we meet you right where you are. We already work with California school districts to help with:  

• Daily case management 
• Case notes in alignment with HIPAA and FERPA to ensure data privacy 
• Customizable access permissions  
• Electronic signature gathering  
• Data analytics and reporting 
• Intern supervision 
• Private insurance and CalAIM billing claims 

Start building success for the 2024-2025 school year and prepare for AB 483's easier access to CalAIM billing opportunities today! Take the first step by partnering with Exym, a software provider familiar with CalAIM and California billing requirements, and already trusted by local California schools.

Visit our Schools Page to learn more about Exym software for schools, or our Finance Page to see Exym’s billing features.  

Click on the button below to schedule a demo with an expert who can answer your questions about using Exym EHR software for schools!