Superintendents are concerned cuts to Medicaid will threaten crucial medical services.

Edwin RiosJul. 24, 2017 3:15 PM

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On the eastern end of Michigans Upper Peninsula, Rachel Fuerers school district depends on more than $870,000 in Medicaid funds each year. About 5 percent ofits overall annualbudget, the money goestowardprovidingmedical services for more than 1,000 special education students in 19 public schools across 4,000 square miles.

Those dollars, though, will be at risk if Republicans in Washington get their way.

Lastweek, Senate Republicans effortsto repeal and replaceand then just repealObamacare appeared to be dead. But now, at President Trumps urging,senators are again poisedfor avote on some sort of health care overhaul thisweek, though it remains to be seenwhether theyll vote ona partial repeal of the Affordable Care Act (ACA)or a full repeal and replace effort.

What is clear is thatpassing either bill would greatly endanger the future of Medicaid.Therepeal and replace bill, the Better Care Reconciliation Act (BCRA), imposes a cap on Medicaid spending that would sharplyreduce funds in future years. The alternative, a bill introduced by Senate Majority Leader Mitch McConnell (R-Ky.) lastweek that mirrors a 2015 effort to mostly repeal Obamacare, would shrink Medicaid spending over the next decade, especially for people who were newly eligible to receive Medicaid through the ACA.

Though McConnell currently lacks the votes to ensure either bills passage, school officials and advocates are keeping their eyes trainedon theSenate.

Were being told that special education is being spared,says Fuerer,who works as special education director at MichigansEastern Upper Peninsula Intermediate School District, but thats not true at all if there are cuts to Medicaid.

Fuerer joined hundreds of school superintendents from across the country in recentweeks indescending uponWashington to lobbyCongress, meeting with their states representatives to convince them to leave Medicaid alone.Theyre lumping everything together in this repeal and replace, Fuerer says. In doing so, they are trying to fix something thats not broken. Medicaid isnt broken.

ToFuerers surprise, even just the fewHouse members she met with the otherweek didnt fully understand the extent of just how much schools rely on Medicaid dollars.While the programis primarily used to fund health insurance for low-income families,italso doles out billions of dollars each year directly to school districts to fund special education services that are mandated by federal law and to supportservices for poor students.Nowschool superintendents, from both red and blue states, are expressingconcern that the GOPs health care plans would forcedistricts to struggle to provide crucialservices for their most vulnerablestudents.

Intalking about the bill as a repeal of Obamacare, Republican rhetoric can be misleading. BCRAwould fundamentally remake Medicaid, a program that has operated since 1965,slicingspending by$772 billion over the next decade andleaving 15 million morepeople uninsured.It does this by turning Medicaid from an open-ended promise from the government to fund state needsinto a block grant or per capita programstarting in2020 that will limit the amount of money each state receives.

Currently,John Hill, executive director of the National Alliance for Medicaid in Education, estimates thatalmost half the children in this country are on Medicaid. So any cut is going to have an adverse effect on kids, no matter how much theyll assure us its not going to happen,Hill tellsMother Jones.

As mandated by the Individuals with Disabilities EducationAct (IDEA) from 1975, schools must provide a free and appropriate public education to students with disabilities. But Congress has historically fallen short on covering the cost of educating special-needs students under IDEA, so states and local agencies have turned toMedicaid tohelp offset the difference and paythe cost for medical services and equipment. Starting in 1988, schools, like hospitals and insurance providers, have been able to request reimbursements from the Department of Health and Human Services for such expenditures.

In 2015, schools received nearly $4 billion in Medicaid funding, according to the Center on Budget and Policy Priorities, less than a third of whats doled out for special education spending under IDEA.

That $4 billion has been essential to schools covering the costs of speech and physical therapy, behavioral services, and medical equipment, such as wheelchairs and walkers. For low-income students, districts use such funds to pay for vision, hearing, and other healthscreenings, as well asforschool nurses and mental health services. Its also important to note thatschool districts dont just offer services to poor and disabled students during school hours; they act as a connecting point to enrolleligible low-income families in Medicaid and in the Childrens Health Insurance Program and help families find health care providers. In turn, schools get reimbursed for their outreach efforts.

Sherri Smith, thesuperintendent of Lower Dauphin, a suburban Pennsylvaniaschool district of just 4,000 students, was also in D.C. recentlyto meet with representatives. She says the small but targeted $50,000 in Medicaid funding her district receives each yearhelps pay for more medical-related services, such as occupational and physical therapy, along with mental health services to serve a growing need for students in the district. The money also allows the district to pay for additional nurses and personal care aides for students with disabilities and low-income students.

Schools are doing more outside the peripheral of just teaching and educating, Smith says. So actually getting Medicaid dollars for medical services for our students, which they need, allows us the opportunity to do so. Im afraid that without those kinds of dollars, that will go away.

In the broader Medicaid landscape, funding for school districts is just onetiny line item. The National Alliance for Medicaid in Education projects that school districts receive less than 1 percent of all Medicaid reimbursements.

Whileneither the House nor Senate repeal-and-replacebill specifically targets funding for schooldistricts, with lessmoneycoming from Washington, states would be forced to make cuts elsewhere in their budgets, which could impactthe entire community. Districts might be pushedto raise taxes, reduce spending on general education programs, or cutstaff.

If schools opted to diminish services for special education students, they could be at risk of falling out of compliance withfederal law, opening districts up to lawsuits and a potential furtherloss of federal dollars. This is all the more complicated due toa recent Supreme Court ruling that raisesthe standard for what schools mustoffer and expands students rights.

We would have to be stringent on services if Medicaidfunding went away, Smith, of Pennsylvania, says. Depending on what types of services, if that child needs it, and its mandated in their individualized education plan under IDEA, then we would have to provide those services. Wed have to find our money, which means we would have to go back to our taxpayers in Pennsylvania, or we would have to look to cut from our regular programs to make up the difference.

Similarly, for Fuerer in Michigan, the cuts to Medicaid funding in the proposedhealth care billswould mean that her district might need to slashitsoverall budget just so the same level of services can be provided. The reality is, [the loss of Medicaid funding is]probably not cutting a speech provider. Its probably cutting a gen ed teacher, she says. If you weaken the general education services, you are weakening the entire school community.

Sasha Pudelski, assistant director of policy and advocacy for the School Superintendents Association, says that changes to Medicaid could put schools in competition with hospitals and insurance providers for Medicaid dollars. Schools cant compete with other frontline healthcare providers for those dollars, Pudelski says. From our perspective, it could end Medicaid as we know it in schools.

Fuerer attended three meetings with Michigan representatives when she was in Washington this month, at least one of which really surprised her.When she sat downwith freshmanRepublicanRep. Jack Bergman,she says,he had never heard about the Medicaid billing in schools and he listened very intently. He didnt commit to changing his position, she says. He voted for the House bill. But he was interested and asked us for more information. It was better than the other ones.

Fuerer also met with an aide toRepublican Rep. Justin Amash, whovotedyes onthe House bill that includedcuts to Medicaid spending similar to those in the Senate proposals. In themeeting, Fuerer recallsthe staffer saying that Amash believed that responsibility for funding education and healthcare should be left to states. Fuerer says she finds that response a little frustrating.

Chris Kjolhede, co-director of the school-based health program at Bassett Healthcare Network, which runs in-school health clinics across 15 school districts in rural upstate New York,says that though its still tooearly to know the extent of damage on schools in the GOPs legislation, it is terrifying to think about major cuts to Medicaid. He says roughly half of children who work with his program receive care as a result of Medicaidfunding andNew Yorks Child Health Plus program.

Kjolhedes program relies on the federalfunds to provide dental, physical, and mental health services for more than 7,500 kids. He adds that Bassett has advocatedwith elected officials to let them know that the group was concerned about the loss of Medicaid reimbursements in his red district. If the funding goes away, theoretically, I have to figure out how to pay for the services or the services go away, Kjolhede tells Mother Jones. Theres a lot of pressure on those of us trying to make it happen.

Edwin Rios is a reporter at Mother Jones. Reach him at erios@motherjones.com.

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