Federal legislation introduced to block plan to cut Medicaid reimbursements to schools
Federal legislation has been introduced to block the plan by the U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS) to cut Medicaid reimbursements to schools for services they provide to students with disabilities under the Individuals with Disabilities Education Act (IDEA). CMS estimates it can save $615 million in fiscal 2007, and $3.65 billion over five years, by not reimbursing schools for the costs of transporting students to the services and administering the program. Payments for basic services would be unaffected. However, U.S. Senator Edward M. Kennedy (D-MA) and U.S. Representatives John D. Dingell (D-MI), George Miller (D-CA), and Edward Whitfield (R-KY), have introduced a bill, the Protecting Children’s Health in Schools Act of 2006, that would keep those payments coming. Unless Congress specifically blocks CMS from enacting the proposed cuts, they can be accomplished without congressional approval after the HHS budget is approved. Chrisanne L. Gayl, the director of federal programs for the National School Boards Association (NSBA), says the bill is now in the process of attracting co-sponsors.
An NSBA fact sheet contends schools play an important role in identifying children who are eligible for Medicaid and connecting those children with services. It warns that eliminating the administrative reimbursement would result in services for fewer children. The proposed legislation also attempts to clarify requirements for states to get payments from CMS. Local school districts complain that the process of seeking reimbursement is cumbersome and point out that some of the information from the federal government on appropriate billing practices has been conflicting. The concern over reimbursement for transporting students to services is serious. According to Mary M. Kahn, a CMS spokeswoman, "general transportation to school is not a Medicaid service. The money for those types of things has to come from education budgets." However, in some cases transporting a student to school where Medicaid services are provided is reimbursable. The rub is that the current rules make it difficult for school districts to know when they can and cannot obtain reimbursement. "What CMS wants is for us to transport kids to an off-site center and have the services done there, because that fits their view," says Bruce Hunter, chief lobbyist for the American Association of School Administrators. Providing reimbursements to schools, he says, "does not fit the traditional, historic medical model." The NSBA fact sheet notes some districts have used the transportation reimbursement to equip buses with special equipment needed by children with more severe disabilities.
Illinois is joining the protest over the CMS plan. U.S. Senator Dick Durbin (D-IL) and U.S. Representative Danny Davis (D-IL) have joined superintendents from Chicago, Elgin, Carpentersville, and other downstate school districts to call attention to the proposed cuts. Illinois school districts stand to lose as much as $132 million in Medicaid payments, with Chicago Public Schools alone losing $38 million. "This is one of the most significant cuts we're facing in an education-related program," says the NSBA’s Ms. Gayl. "It's going to have a ripple effect because more money will be directed at special ed at the expense of regular ed kids." CMS officials disagree. "We believe the financial impact on the schools will be minimal," says CMS spokesman Peter Ashkenaz. "It doesn't impact the services the children receive." Based on a 2005 U.S. Government Accountability Office report that found Georgia and Massachusetts reportedly overbilled Medicaid for millions in "unallowed" expenses, CMS has instituted a new paperwork rule that will require a district to get permission from parents every time it offers medical services to a disabled student if it wants to get reimbursed. Under the current rule, a district gets permission once, when parents sign off on a treatment plan. Under the new rule, school officials predict that the weekly or monthly paperwork requirement will make it nearly impossible for large districts to qualify for Medicaid dollars. According to Ray Anderson, a federal lobbyist for the Chicago school district, the proposed Medicaid cuts are too small to make a real dent in the federal budget. He contends the new reimbursement rules reflect the philosophy of the Bush administration that "schools should not be in the business of providing health care."
Education Week
By Christina A. Samuels
[Link to full story]
Chicago Tribune
By Tracy Dell'Angela
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[Editor’s Note: Education Week also reports below that Alexa Posny, Director of ED’s Office for Special Education Programs, has verbally clarified the new requirement contained in the final regulations for the 2004 reauthorization of IDEA that a district notify parents "each time" it seeks Medicaid reimbursement. This is not, she explains, intended to require a separate parental consent each time the district submits a reimbursement request for services a child receives. She indicates one possible way to comply is to have parents sign a release form each year when the child’s Individualized Education Program (IEP) is developed. However, current rules in some states that allow Medicaid beneficiaries to sign blanket release forms just once, when they enroll in the public program, no longer comply. Background on the recurring legislative and legal battle over attempted cuts to Medicaid reimbursements to schools, including the NSBA fact sheet, is available starting at the second link.]
Education Week
By Christina A. Samuels
[Link to full story]
[NSBA School Law pages on CMS Medicaid cuts]