Medicaid caps in health care bills could push more special needs costs onto schools – Milwaukee Journal Sentinel
Washington Bureau Chief Craig Gilbert on the Republicans unveiling their healthcare overhaul.
Addie Hart-Ellis starred in the school play, sat on student council, played an instrument and joined the baseball team at Whitefish Bay Middle School last year, all thanks in part to Medicaid.
The 13-year-old is nonverbal and has cognitive disabilities and like more than 118,000 students with special needs in Wisconsin schools, the medical services she receives during the school day are paid for in part by the federal funding stream.
But that could change under the recently passed House health care bill and the Senate bill now under consideration.
Both bills would put caps on Medicaid funds to states — which in turn could leave school districts on the hook.
“Ultimately, we have to provide those services,” Wauwatosa Superintendent Phil Ertl said. “The money is going to come from somewhere, so we’re going to have to figure out where that somewhere is.”
Nationwide, Medicaid provides health care, long-term care and other services to roughly 74 million people. That includes 1 million — more than one in six — in Wisconsin.
In schools, every special needs student receives an individual education plan agreed on by educators and parents. The services are mandatory; school districts are legally obligated to meet those students’ needs.
Medicaid funds are used for audiology services, speech therapy, physical therapy, nursing assistance or other medical equipment or services as outlined by the plan. Medicaid funds also can be used to pay for nurses, psychologists and guidance counselors.
The bill passed by the House to replace parts of the Affordable Care Act would change the way the cost of Medicaid programs is shared by the federal government and states, limiting future increases in federal funding and putting more of the onus on states.
The draft of the Senate’s version of the bill released Thursday would lower future spending on the program even more than the House bill.
In Wisconsin, more than $187 million is spent on school-based medical services annually, and Medicaid currently provides a little more than $107 million, or 57%, of the total cost, according to figures from Disability Rights Wisconsin.
If the federal contribution is capped, and the state can’t — or won’t — pick up the additional portion, then the districts would have to pick up more of the costs. Wauwatosa’s Ertl called that an unfunded mandate.
Glendale-River Hills Superintendent Larry Smalley said his district spends about $2.8 million for school-based special education services every year and receives about $1 million from Medicaid to supplement that spending.
“I can’t reduce my special-education budget,” Smalley said. “If I’m spending $2.8 million this year, I have to spend that next year.”
If the Medicaid contribution shrinks, Smalley would have to take money away from other parts of the school budget.
While only 12% of the population utilizes special-needs services, he said, the other 88% will be affected because districts will have to dig into their general funds, cutting other areas to pay for the mandated services previously covered by Medicaid.
In other words, a cap on federal Medicaid spending in Washington might lead to a cut in a school music program in Wisconsin.
Pam DeLap, an Oshkosh resident and mother of an autistic son, hosted an information session last Wednesday at Oshkosh West High School along with Lisa Pugh, state director of The Arc Wisconsin, an advocacy group.
The Oshkosh School District receives about $500,000 through Medicaid to help serve its 1,600 students who receive special services.
“Your child might not have a disability, but your child goes to the same public school my child does,” DeLap said. “If you take away that (money), how do you make it up? You take it away from general operating, it’ll take away something from your child. It might take away a club sport or art class.”
Sally Flaschberger, lead advocacy specialist at Disability Rights Wisconsin, said another possibility would be shaving costs by excluding students rather than including them in mainstream classroom settings, and by grouping children together rather than providing them with individual attention.
Milwaukee Public Schools receives about $5 million through Medicaid to pay for school-based medical services.
“We’re concerned because it is an attack on what we consider is vital to our students,” said Jennifer Mims-Howell, senior director of specialized services for MPS.“We don’t deny any student any services. If funds get cut, it alters the thinking for all of us to get creative to make sure a child can get what they need.”
Pugh said special services to students are already lacking in funding, even with the current government support.
“I don’t know how a school district makes up a half a million dollars,” Pugh said about the potential burden.
State and federal spending totaled $545 billion in fiscal 2015, according to the Kaiser Family Foundation.
Supporters of the caps on federal Medicaid say the program is unsustainable as currently designed. They also trust that putting more of the program in state hands would free up creativity to find new approaches to providing care.
The National Association of Medicaid Directors issued a statement Monday that said the proposed growth rates in the Senate bill are insufficient and unworkable and no amount of flexibility would compensate for what reductions may occur.
Wisconsin Republican Ron Johnson is still withholding his support from the Senate bill, saying more time is needed to properly assess the consequences. Wisconsin Democrat Tammy Baldwin is opposed, saying the Senate bill would provide “high costs, fewer children on health care coverage, and more economic insecurity.”