While the vast majority of Medicaid dollars are spent on medical providers and long-term care, a tiny sliver also funds school-based healthcare and support services for low-income children and students with disabilities.
New Jersey schools received $143 million for this work in 2015, the fourth-highest level of funding nationwide, according to a recent report by the national Center on Budget and Policy Priorities, a nonprofit research and policy institute. It helps pay for school nurses, dental and vision screenings, disability assessments, individual care, wheelchairs, hearing aids, and more. These services enable students to remain healthier, stay in school longer, and grow up to become more productive adults, the report notes.
Funding in jeopardy
Garden State educators have worked hard to maximize their federal funding for these programs. But these dollars may now be in jeopardy as government leaders in Washington, D.C., debate cuts to the federal Medicaid program, report author Jessica Schubel warned. “Cutting federal Medicaid funding would reduce the access and quality of care provided to students while also hurting school budgets,” she wrote.
As Republicans in Congress struggle to replace the landmark Affordable Care Act, they have focused on ways to control the cost of Medicaid, proposing capped payments or block grants to states that will provide more flexibility, but fewer federal dollars overall. Medicaid spent nearly $4 billion on school-based services in 2015 and, while this is just 1 percent of the program’s total budget, Schubel and other are concerned that schools depend heavily on this funding to provide for their most vulnerable students.
Experts at New Jersey Policy Perspective, a progressive research organization that has closely tracked Medicaid spending here, said the cuts now under discussion put these programs at risk. “Without the support they get from Medicaid, some New Jersey schools would struggle to afford keeping nurses and counselors on staff, give students with disabilities the services they need and are entitled to receive, and provide basic screenings for Medicaid-eligible children,” said Jon Whiten, NJPP’s vice president.
Last month, a report by NJPP’s director of health policy, Ray Castro, found nearly half a million state residents would lose health insurance if the GOP-envisioned reforms are enacted and billions in costs now covered by the federal government would be shifted to the New Jersey budget. The changes could also eliminate healthcare jobs and put a big dent in the local economy, he warned.
Medicaid goes to school
Schools use Medicaid funding in several ways. They tap into the federal program to cover healthcare screenings for low-income children who are enrolled in the public insurance program and for healthcare staffing, like school nurses and speech therapists, which are accessible to all kids. Many districts also use the funding to provide asthma, diabetes, and other chronic-disease education programs; to supplement early-intervention screenings; or to connect Medicaid-covered students to healthcare or social services outside of schools, according to the center’s report.
Education officials can also access Medicaid to help fund health-related services for disabled students, as long as it is required by their personalized education plan as a necessary service for their learning. This can include a personal nurse, or specialized therapy, as well as assistive technology. While federal funding through the Individuals with Disabilities in Education Act provides some of the resources for their education, it is never enough, so Medicaid is used to fill certain gaps, according to the report.
“Schools’ ability to leverage Medicaid funding ensures that they can provide the wide range of services needed to educate students with disabilities and ensure their compliance with IDEA requirements,” Schubel wrote. “Medicaid also helps schools by reducing special education and other healthcare-related costs, freeing up funding in state and school budgets to help advance other education initiatives.”
To be eligible, schools must register as Medicaid providers. A spokesman for the state Department of Education said officials do not regularly track how many districts have done so, but the practice appears to be widespread. Nearly 17 percent of the state’s 1.37 million students are classified as special education pupils, a group that includes kids with learning disabilities, health and language disabilities, and autism, among other conditions.
Follow the money
In 2015, New Jersey spent nearly $287 million on school-based Medicaid services, some $143 million of which came from the federal government and the rest from state dollars, according to the center’s report. Only Texas, Michigan, and Illinois received more federal funding. New York spent nearly $274 million and got $137 million from Washington; Pennsylvania invested $253 million and collected $131 million in federal money.
Diana Autin, executive co-director of SPAN, the Statewide Parent Advocacy Network, which helps families connect with school, health, and other services, agreed the state DOE and Garden State schools have succeeded in accessing Medicaid dollars for these critical services. But sometimes these benefits have a down side: less money for care outside of class.
For example, Medicaid caps the nursing hours it will pay for, so if students obtain more care at school, their parents may be left without help for several hours at home, Autin explained. Other services come with similar limits. Sometimes, the health maintenance organizations that manage Medicaid plans impose similar rationing, she added.
“The state has done a relatively good job of getting districts to be eligible” for the program, Autin said. “But it should not result in children getting fewer services in the community or at home.”