Blog owner’s note: I asked a friend to prepare this for me. Many times I hear from parents that they are refusing to sign the Medicaid form, the one that would allow your school to bill Medicaid for some of your child’s services. While I have been in your shoes, I highly recommend that parents sign it. Most of the time parents are refusing, in my opinion, it is because you feel powerless and want to have some power. If you are disagreeing over the IEP, I would suggest you seek other ways to resolve it, besides denying funding to the school. What is being proposed in our federal government right now, as far as eliminating this funding, will be disastrous for our kids.
Please also note that the author of this post is a long-time school superintendent in Pennsylvania. Some of the specifics may vary for your state.
But, please, don’t delay. Call your Congressman today and ask them to oppose the AHCA.
If you are the parent or guardian of a child receiving special education services, chances are you have had a conversation about Medicaid (also called Medical Assistance or Medical ACCESS) with school professionals. Parents are sometimes confused, hesitant or even taken aback by the inquiry about these services. Many people simply do not understand the connection between Medicaid, a health service, and education. In fact, Medicaid plays a critical role in public education for a number of reasons.
First and foremost, in order for children to get the most benefit from education, they must be healthy. When children have unmet health needs, learning is almost always impacted. Currently, children constitute 44 Percent of Medicaid beneficiaries. Many children are covered by or eligible for Medicaid because of their family income level. For these families, the absence of or reduction in Medicaid, will equal the absence or reduction of needed health services. Many children with disabilities that limit their ability to perform basis functions consistent with their age level, can qualify for Medicaid regardless of their family income. Children with disabilities often require treatments and therapies outside school and Medicaid can be critical to making such services affordable to families.
When a child has Medicaid, school personnel may ask for consent from the parent or guardian to bill for services. Parents often wonder why schools are billing and how this might impact health services for their child outside of school. It is important for parents to understand that the services that a school may be able to bill for have no impact on other health services provided to their child outside of school. Parents and guardians sometimes worry that if the school is billing for services, the health services available to their child outside of school will be used up or limited. This is not the case.
Congress first authorized the Education for All Handicapped Children Act, the law which would later be reauthorized as the IDEA, in 1975. That authorization came with a promise to fund 40 percent of the cost to public schools for providing the services mandated under this act. Congress has never fulfilled this funding promise but in 1988, it authorized a mechanism to funnel more federal dollars into the schools.
The School-Based Access Program allows for public schools to bill for reimbursement for medically necessary health-related services that are part of a child’s IEP. Such services would include things such as speech or occupational services, nursing services and even specialized transportation services. The reimbursement rate represents a fraction of the actual cost to school districts of providing these services to students. Nonetheless, SBAP is an important funding stream for public schools. The National Alliance for Medicaid in Education estimates that $4-$5 billion of Medicaid reimbursement goes to the nation’s public school districts yearly.[i]
The Medicaid Block Grant program being proposed in Congress right now, is estimated to result in a 30 percent reduction in Medicaid reimbursement dollars to schools.[ii] In Pennsylvania alone, the proposed block grant program could mean a reduction of more than140 million in federal funding for schools. [iii] A reduction in Medicaid targeting SBAP would have severe consequences for public schools and potentially for services for disabled and non-disabled students. Medicaid reimbursement is a critical funding stream that allows districts to provide the specialized instructional supports and other medically necessary services to children with disabilities. Reducing these funds would mean:
- Fewer services: Providing comprehensive physical and mental health services in schools improves accessibility for many children, particularly in high needs and hard to serve areas such as rural and urban communities. Reduced funding for Medicaid would result in decreased access to critical healthcare for many children and youth.
- Higher taxes: Many districts rely on Medicaid reimbursement to cover personnel costs for special education programs and other school-based health services. A loss in Medicaid reimbursement could lead to deficits in districts that require increases in property taxes or new levies to cover these costs.
- Cuts to general education: Cuts in Medicaid funding would require districts to utilize funds from other sources to provide the medically necessary services mandated under IDEA. The subsequent reduction from other sources could result in elimination of programs in “non-mandated” areas of regular education.
- Job loss: Cuts to Medicaid funding would impact districts’ ability to maintain employment for specialized instructional support personnel (related services) who ensure students with disabilities are able to learn and succeed in school.
- Fewer mental health supports: Seven out of 10 students who need mental health services receive those services at school. Cuts to Medicaid would further marginalize these critical services and leave students without access to care.[iv]
All parents with children in public schools, disabled or not, should understand and support the School-Based Access Program; a critical funding stream for public education.
[i] Biennial State Survey of School Based Medicaid Services. April 2014.
[ii] Pudelski, S. Cutting Medicaid: A prescription to hurt the neediest kids.
AASA, The School Superintendents Association. Jan 2017
[iii] PA’s School-Based ACCESS Program is jeopardized under proposed federal cuts to Medicaid. PSBA, a Closer look. https://www.psba.org/wp-content/uploads/2017/03/ACL_ACCESS-program-jeopardized.pdf
[iv] LDA Congressional Visits Talking Points Memo. 2/12/17
 Biennial State Survey of School Based Medicaid Services. April 2014.
 Pudelski, S. Cutting Medicaid: A prescription to hurt the neediest kids.
AASA, The School Superintendents Association. Jan 2017
 PA’s School-Based ACCESS Program is jeopardized under proposed federal cuts to Medicaid. PSBA, a Closer look. https://www.psba.org/wp-content/uploads/2017/03/ACL_ACCESS-program-jeopardized.pdf
 LDA Congressional Visits Talking Points Memo. 2/12/17
That is from one superintendent, now hear from another:
This went to parents of the West Chester School District a couple of days ago. March 20, 2017
Dear Members of the Legislative Action Committee,
The Federal House of Representatives is planning to vote on Medicaid reform as part of the replacement bill for the
Affordable Care Act. A vote could come as early as Thursday March 23. The loss in Medicaid funding has a
significant impact on WCASD. We currently apply for Medicaid access funding each year to help pay for expenses
to offset costs to students with medical disabilities. We receive approximately $350,000 per year for these funds
to help provide nurse services, physical therapy, personal care aides, and necessary equipment including walkers,
wheelchairs and assistive technology devices to some of our most needy children.
Parents also access these funds to help pay for services in the home. They too will have fewer dollars available to
help offset costs.
If Medicaid Access is cut, we will need to find an additional $350,000 in our budget to make up that loss of
funding. The services are needed, and required as per each child’s Individual Education Plan (IEP). While the Feds
may be able to cut the revenue, we are not legally allowed to cut the expense!
Please contact the members of the House representing our district. I don’t believe either one of these gentlemen
want to see students lose services with this plan. (please only contact if they are YOUR legislators! Find yours and contact!)
Rep. Ryan Costello – WC phone 610.696.2982, WC fax 610.696.2985, DC phone 202.225.4315, to email follow
Rep. Pat Meehan – DC phone 202.225.2011, DC fax 202.226.0280, to email follow prompts:
A phone call works great. Second option would be to fax a letter. Emails take too long going through the vetting
process. Simply ask them to vote “no” on the re-authorization of the Affordable Care Act until the Medicaid issue can
Here is some additional information recently released by the Pa Association of School Administrators (PASA), on the
Medicaid Update – The ACA replacement bill contains per capita caps on Medicaid, which could have dramatic
negative implications on School-Based Access Funding, as Medicaid funding available to states would be reduced
and schools would have to compete with hospitals and others for limited funding. Under the proposed legislation,
Pennsylvania could lose over $140 million in federal funding now provided for the ACCESS program. If this happens,
local schools will not be able to afford the special education programs they are legally required to provide. Worse,
children could be left without critical health services and supports to help them be healthy and achieve academically.
Needed services include speech therapy, physical therapy and equipment, psychological services, nurses and
personal care aides, and specialized transportation; and necessary equipment includes walkers, wheelchairs and
assistive technology devices. The need for continued, adequate Medicaid funding is important to schools and
children. Please reach out to your representatives and senators in DC on this important issue ASAP.
Thanks for your help.
West Chester Area School District
Now that you’ve read some, please act, find your legislators and contact them!