Delay in Medicaid to Schools rulemaking means loss in available federal funding for NH schools

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A delay in the rulemaking process by the New Hampshire Department of Health and Human Services (DHHS) means school districts in New Hampshire will start this school year without additional federal funding made available by state legislation in 2017.

The state legislature passed a law in 2017 that allows districts to receive federal funding for student services like mental health counseling, hearing services, speech therapy, and occupational therapy, that support students eligible for Medicaid but who do not necessarily have an Individual Education Program (IEP). Known as “Medicaid for Schools” program, these funds were, before 2017, only available for students with IEPs. But due to the legislation passed in 2017, the program can now include any child that is eligible for Medicaid. 

The state law required DHHS to start a formal rulemaking process by September 1, 2017, which the Department met. But the process isn’t finished yet, meaning schools won’t be able to bill the federal government for the funds until it is. 

From the Associated Press:

Parents and advocates are frustrated that the work remains unfinished heading into the new academic year.

“It’s a significant assistance to public schools, and the only reason it’s not in effect is because of the failure to implement the program as required,” said Michael Skibbie, policy director at the Disability Rights Center of New Hampshire. “We don’t know exactly how much is being left on the table by failing to implement this program, but we think it’s pretty significant. It’s a real problem.”

LeeAnn Bowen, of Merrimack, has a 9-year-old daughter who is covered by Medicaid and has an IEP. But her 5-year-old son isn’t covered and doesn’t have an IEP. She said she has unsuccessfully pressed the school district to provide services to help with his lack of core strength and other issues. Even if he wasn’t eligible under Medicaid to Schools, she wishes it was implemented so it could free up money for other students.

“I don’t understand why some children get it and some don’t,” she said.

In a letter to the Disability Rights Center and others in May, DHHS Commissioner Jeffrey Meyers said the department “will initiate formal rulemaking early this summer so that this program is in place by the beginning of the 2018-2019 school year.”

But Christine Santaniello, the director of the Division of Long Term Supports and Services, said a draft amendment to the existing program rules won’t be presented to the legislative committee that must approve changes until sometime in the fall.

The department did meet the Sept. 1 deadline to start the process, Santaniello said, and since then officials have researched what other states have done and have met with school districts and other stakeholders.

“It’s a process, and it’s complicated. We want to do it, and do it right,” she said in an interview. “We’re also doing it within our existing staff resources.”

Santaniello said 63 percent of schools participate in the current program. That resulted in $27.9 million from the federal government in fiscal year 2016, according to the New Hampshire Fiscal Policy Institute.

Skibbe said schools already are providing many of the services, but he also believes there are children who are going without. For example, he said more schools would be able to participate in efforts to better coordinate services between schools and community mental health centers if they had more funding. It’s unclear how many additional students might benefit from the funding.

“It can’t be demonstrated, but I believe there are services that would be provided if schools could just get across the threshold to being able to afford them,” he said.

Rebecca Whitley, the policy coordinator for the New Hampshire Children’s Behavioral Health Collaborative, spoke with NHPR about the program:

What is the impact of the state’s failure to put this in place for this upcoming school year?

It’s really difficult to estimate the exact amount of federal dollars that have been left on the table but there’s no question that substantial federal dollars to support financially strained school districts have been permanently lost.

Does this mean schools are not offering certain services to students or that they’re just not offering as much of that service or being reimbursed as much as they normally would be?

There are some school districts that are already providing these services, particularly larger school districts with larger budgets but they’re not able to capture the 50 percent match from the federal dollars. So there are some school districts that are paying 100 percent of the cost of these services when they could access federal dollars to support half of those services. And there are some school districts, smaller school districts perhaps, that aren’t able to offer these services at all because of the cost. The expansion of this program would allow these school districts to start offering these supports to students.

Why is it important for schools to take advantage of this?

I think particularly now our state is grappling with mental health and substance use crises. The delay in implementation has lost all these federal dollars that a lot of financially strained school districts really want to provide, hope to support children and their families.

Medicaid provided over $29 million in funding for students with IEPs in 2016, and every school district in the state currently accepts the funding. Here is a breakdown of how much each school district in New Hampshire received in 2016 through the Medicaid to Schools program, according to data from the Department of Health and Human Services.

Source: Schools to reopen without expanded Medicaid program, Associated Press, & N.H. Schools Not Yet Receiving Expanded Medicaid Funds, New Hampshire Public Radio