MOORE HAVEN -- It seems the Glades County School District’s Medicaid reimbursements for the past nine months has fallen into a black hole of government bureaucracy.

The Florida Dept. of Education Medicaid system reimburses Medicaid-enrolled school districts that employ or contract staff that provides Medicaid covered services to recipients in school.

Andrea Schillinger, director of Exceptional Student Education, told board members during the Aug. 18 regular school board meeting that she’s been trying to find out why the FDOE says the district has not applied for Medicaid even though it is registered on its site as recipient. 

Schillinger took on the role of working with the district’s Medicaid program early in 2021, and started working with Sivic Solutions Group, a New York based consulting, systems and operational firm which handles the heavy lifting of billing and other associated tasks when contracted in March.

“Sivic Solutions got our finance department enrolled,” she said.

The company provides programs for service providers to enter information that allows the district to pull reports and other information entered by providers, provides the right medical billing codes so when providers enter information the coding is correct, and most importantly, saves the district time and money by combining smaller school districts together in order to meet the criteria of random sampling to the state.

“As a small district we would be required to do 600 random samples and that would kill us,” she said. “Being a part of Sivic Solutions we don’t have to do 600 samples because it’s split up among the districts that they work with. Sivic Solutions may have to send 600 samples, but we only have to send one.”

Billings occur every three months and if there are snags, as in the case of Glades School District, it means a wait of another three months to reapply and for the past three cycles the district has been denied.

“Now, we’re nine months out because they billed for the third time and were denied,” she said. “So right now we’re billing back from August.”

At one point, Schillinger thought Sivic Solutions was to blame and stopped paying the contract.

“If they can’t bill for us, why pay?” she said.

But she said Sivic Solutions has since produced email conversations showing it was actively trying to rectify the situation and Schillinger learned from the FDOE the school district was not technically enrolled because “someone” told the agency Glades County wasn’t participating in Medicaid billing because the staff was federally funded.

“Which has never been the case and is not accurate information,” she said. “We do qualify to bill for Medicaid because we pay for our staff partially out of IDEA federal funds but partially out of our general fund as well as some of our ESA grants.”

She even sent a screen shot to the FDOE of the approved FDOE Medicaid ID number, although it shows zero payments.

Schillinger wants to get the situation resolved soon as there is only about a year to refile the previous billings.

School Board Attorney Mike McKinley wondered if somehow state and federal governments got their wires crossed. Superintendent Dr. Beth Barfield suggested perhaps the ID number had deactivated when not in use.

Schillinger said her next step was to reach out to the federal program to see if something was going on there causing the problems.

In any event, Schillinger recommended not pulling out of the Sivic Solutions contract, which expires in 2023, but using the time in between now and then to consider other options.

“We have 5,000 billable claims that are out there waiting to be billed. So if we drop Sivic Solutions now we would lose all that.”

Board member Patricia Pearce agreed with keeping the contract for now but said the initial investment into Sivic Solutions or another service three years ago of $100,000 has brought them no return.

“All we’ve done is pay money out and not get anything back for our investment,” she said “So when that contract ends if we’re not making money, then I’m not going to be in favor of continuing it.”