An unexpected constituency is nervously tracking the progress of the American Health Care Act, the GOP’s proposal to repeal and replace Obamacare – schools.
The AHCA, which narrowly cleared the U.S. House last week, would dramatically restructure Medicaid from a program that reimburses – at least in part – whatever eligible expenses providers bill for to a per-capita capped program. The GOP bill would give the program $840 billion less over 10 years to spend.
That could deal a big blow to school districts, who rely on Medicaid to help defray the costs of certain medical services provided to students with disabilities. In 2016, Medicaid reimbursements to New Hampshire school districts totaled $29.3 million, according to Department of Health and Human Services records.
The AHCA doesn’t specifically target or cut funding for special education in schools. But advocates argue that with a smaller, finite pot of Medicaid money, states will be forced to ration dollars – and potentially cut eligibility for schools entirely.
“So when you have fewer dollars, and you still have the same number of people – if not more people – who need to be covered by Medicaid, you’re going to have to be in a position as governor, or state Medicaid director, of deciding who will get reimbursement and who will not,” said Sasha Pudelski, the assistant director of policy and advocacy for AASA, the school superintendents Association.
The Concord school district received just a little under $1.2 million in Medicaid reimbursements in 2016, according to state data the Merrimack Valley school district was reimbursed nearly $480,000, Bow got a little under $320,000, Pembroke took in about $250,000, and Hopkinton netted about $220,000.
The Medicaid to Schools program covers only a fraction of the cost of services provided, said Concord Assistant Superintendent Donna Palley, but it helps pay for things like physical, occupational, language, and speech therapy, vision services, nursing, and even transportation for students with disabilities.
Special education costs are rapidly growing in New Hampshire, but state and federal reimbursements have largely stagnated or dwindled. In most districts, the vast majority of special education costs are paid for with local dollars.
Schools say they have little leeway when it comes to special education costs, which are tied to state and federal mandates surrounding students with disabilities. Advocates say that means cutting Medicaid to schools won’t reduce costs – it’ll just balloon the tab local property taxes are on the hook for.
“Without that Medicaid reimbursement, somebody is going to have to pay for those services that are required by law. And the only ones that are left are the local taxpayers,” said Carl Ladd, director of the New Hampshire School Administrators Association.
This year, the Concord school district budgeted $13.5 million for special education. It received $1.37 million in differentiated state aid and almost $1.2 million in federal Individuals with Disabilities Education Act funding. It is expecting to receive $1.15 million in Medicaid reimbursements.
“So Medicaid is one of the three top sources of funding for us in special education,” Palley wrote in an email.
As elsewhere in school districts across the state, Concord’s special education costs are set to rise again next year – to $15.3 million.
Republican Gov. Chris Sununu has so far declined to back the bill but said he was encouraged by Congress’s efforts to move toward a replacement for the Affordable Care Act.
“This is one of several components of the AHCA that is of concern and we are working to thoroughly analyze its impact on New Hampshire. This item needs to be considered very carefully as the AHCA is moved forward and improved by the United States Senate,” Michael Todd, his spokesman, wrote in an email.
(Lola Duffort can be reached at 369-3321 or lduffort@cmonitor.com.)