WASHINGTON – School superintendents across the country are raising alarms about the possibility that Republican health care legislation would curtail billions of dollars in annual funding they count on to help students with disabilities and poor children.
For the past three decades, Medicaid has helped pay for services and equipment that schools provide to special-education students, as well as school-based health screening and treatment for children from low-income families. Now, educators are warning that the GOP push to shrink Medicaid spending will strip schools of what a national superintendents association estimates at up to $4 billion per year.
That money pays for nurses, social workers, physical, occupational and speech therapists and medical equipment like walkers and wheelchairs. It also pays for preventive and comprehensive health services for poor children, including immunizations, screening for hearing and vision problems and management of chronic conditions like asthma and diabetes.
Many school districts, already squeezed by shrinking state education budgets, say that to fill the hole they anticipate would be left by the Republican push to restructure Medicaid, they would either have to cut those services or downsize general programs that serve all students.
“We'd have to make a local decision about what services we continue to provide and which we don't,” said Paul Gausman, superintendent of a school district of 15,000 students in Sioux City, Iowa.
“I haven't met many people who enjoy writing a check for their taxes, and I understand that,” Gausman said. “But it does not mean taxation is evil, and we've got to consider the most vulnerable of our population.”
Schools have been able to register as Medicaid providers and seek reimbursement, as doctors and hospitals do, since 1988. Two-thirds of districts that bill Medicaid use the money to pay the salaries of employees who work directly with children.
But the Republican push to overhaul health care would have a new “per capita cap” system for Medicaid: Instead of matching whatever states spend on Medicaid, the federal government would instead give them a fixed amount for each Medicaid enrollee.
Under the Senate GOP bill, that change would reduce federal spending about $772 billion over the next decade, according to the nonpartisan Congressional Budget Office. The House GOP version, which passed last month, would cut federal spending $880 billion over the same time period.
Republican proponents argue that controlling federal spending would force the health care system to become more efficient.
Democrats believe that the nation's neediest will be denied essential services – including in schools.
“No matter how they try to spin their massive cuts to Medicaid to make the Senate version look less 'mean,' it is clear that Trumpcare would mean massive cuts to schools and districts and massive pain for students and families,” said Sen. Patty Murray of Washington, the top Democrat on the Health, Education, Labor and Pensions Committee.
The Senate bill, known as the Better Care Reconciliation Act, exempts some of the most disabled children from the per-capita caps, but the number of children who would be affected is not known.
“Health care will be rationed and schools will be forced to compete with other critical health care providers – hospitals, physicians, and clinics – that serve Medicaid-eligible children,” a coalition of more than 60 education, civil rights and child-welfare groups wrote to senators Tuesday.
The Republican plan for Medicaid is likely to hurt schools in several ways, said Sasha Pudelski, who tracks health care policy for AASA, the superintendents' association. Most directly, states may decide to prohibit schools from receiving Medicaid dollars because of stiff competition for limited resources, she said.
Less directly, states struggling to cover health care costs now covered by the federal government would have to seek cuts elsewhere in their budgets, including in education.
Schools receive less than 1 percent of federal Medicaid spending, according to the National Alliance for Medicaid in Schools.
But federal Medicaid reimbursements constitute the third-largest federal funding stream to public schools, behind $15 billion they receive each year for educating poor children and $13 billion they receive to educate students with disabilities under the Individuals with Disabilities in Education Act.
The federal government initially promised to pick up 40 percent of the cost of special-education services, yet has never come close. It now pays only about 15 percent. Medicaid payments have helped fill that gap.
Without those dollars – and facing a recent Supreme Court decision that raised the bar for the services school districts owe students with disabilities – many districts wonder how they will pay for services they now provide.
Cut would not curtail FWCS services
Fort Wayne Community Schools receives about $800,000 in Medicaid reimbursements for physical therapy, occupational therapy and speech language services, Chief Financial Officer Kathy Friend said.
“It's based on actual services provided for Medicaid-eligible students,” she said.
Should funding be reduced, she said, FWCS would continue to provide those services, but the general fund would be affected.
– Ashley Sloboda, The Journal Gazette