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.