The Advocate: August 2017
The summer of 2017 has been one to remember. From shake-ups
at the White House to intense health care debates, it’s never been more
difficult to keep track of everything happening in Washington. While the health
care votes during the week of July 25 were a sign that sometimes policy can
trump politics, we are not out of the woods yet. There are still backroom deals
purportedly underway to try and dismantle Medicaid.
Though much of the
attention appears to be on Obamacare and fixing the problems related to the coverage
in the exchanges, we can’t forget that a
majority of House members and more than 40 Senators support the idea of block-granting
Medicaid dollars to states. These high numbers mean that our work to educate
Congress about school-based Medicaid is far from over.
We can and should relish in our highly-publicized
and highly-regarded
efforts to educate leaders on Capitol Hill, numerous state and national
partners and millions of citizens across this country about school-based
Medicaid. But, we need to keep educating and advocating.
Even if the House and Senate wash their hands of the
Medicaid entitlement conversation for the rest of this Congressional session,
there is a newfound appetite to “trim” Medicaid funding. Let’s be clear: any
trim to the Medicaid program will hit schools, which are not front-line
healthcare providers, first. We can never compete with hospitals, long-term
care facilities, insurers, and other key health care players for limited
Medicaid funding. That’s why these talking points on the importance of Medicaid
in schools should be ones you remember for a long, long time.
In addition to fighting to preserve Medicaid, there is a
smaller battle being waged to protect health care for kids who receive it
through the Children’s Health Insurance Program (CHIP). Before the end of
September, Congress must decide whether to extend funding for CHIP, which
provides health insurance for 9 million children.
CHIP provides health care coverage for kids not quite poor
enough to be eligible for Medicaid. In 15 states, kids eligible for CHIP look
the same as kids eligible for Medicaid, and school reimbursement for services for
CHIP kids as well as Medicaid kids is identical. In 29 states, a smaller
portion of CHIP kids are treated as Medicaid beneficiaries and districts can
also reimburse for the services they provide them.
The stakes are high if Congress fails to reauthorize—every state will exhaust its federal CHIP allotments at some point in
fiscal year 2018 and a few states are expected to exhaust their federal CHIP
allotments by December 2017. As a result, millions of kids will lose health care. Consequently,
your district may lose critical Medicaid dollars and be forced to provide basic
health care services for even more kids to keep them healthy enough to learn. Outreach
is underway in both the House and Senate
to urge them to support the extension of funding for this program.
On the positive side, if Congress continues to treat
Medicaid as an entitlement program for the near future there is a great
opportunity for states and districts to pull down even more Medicaid funding,
thanks to the reversal of the “free care” rule.
In December 2014, the “free care” rule prevented districts from
being reimbursed by Medicaid for providing any service that is ordinarily
provided for free to the community at large, even if Medicaid would cover these
services for its beneficiaries in other contexts. For example, if a school nurse examined a Medicaid-eligible student as part of a universal
screening, federal funds could not be used to cover that exam because all
students would be able to access the service without being charged. The
rescinding of this rule means that the child’s examination would be covered and
reimbursed by Medicaid.
States are already in the process of seeking approval from
CMS to start billing, so it’s worth connecting with other health and education
advocates in your state to pursue whether your state is amending its plan to
allow districts to start billing for these services as well.