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Time Study Plan

School Based Medicaid Administrative Match Program

A majority of school districts in Washington State spend some of their time helping K-12 students get public funded medical assistance (Medicaid) if needed, since good health promotes learning. Districts can then ask to be partially reimbursed by federal Medicaid funds for the staff time/cost incurred in doing some of this work.

The Medicaid Administrative Match Program in the Medical Assistance Administration asked our office, Research and Data Analysis, to devise an efficient way for accurately estimating every quarter how much time schools spend in doing these Medicaid related activities. Federal regulations in the Administrative Match program had become more stringent in their requirements, especially in terms of the accuracy of the estimates and the necessary documentation.

A review of the 2002 school data showed that more than one in three K-12 school students were affected: about 35 percent were Medicaid eligible statewide. The 15 largest school districts, located in larger more prosperous cities had 3 out of 10 of their students covered by Medicaid. This Medicaid ratio increased, as school districts got smaller: Medicaid covered about 5 of 10 students in the 37 smallest school districts.

Not surprisingly we found that time spent by school staff on Medicaid related activities varied by the size of the district and the percentage of poorer/Medicaid covered students. It varied from about 2 percent to 10 percent of total school staff time. We found some evidence that nurses, counselors, social workers and some dedicated teachers or administrative assistants spent about half of this time. Most teachers were busy teaching: they mainly identified problems in students’ health, talked to parents and students, made referrals and monitored progress.

The design for the quarterly time study was an innovative modification of the generally accepted Random Moment Sampling (RMS) methodology. It included random sampling of days and staff, stratified by type of school staff and size of school district. An independent review of the time study design by a foremost statistician, Nayak Polissar, found that the proposed plan was “sound, unbiased, and the precision very likely to meet or better the stated goal of 5%.” The plan was submitted and was accepted by the federal authorities, the Centers for Medicare and Medicaid Services, in 2004.

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Modified: Thursday November 17 2005

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