Public schools would be in a financial pinch if Congressional Republicans are successful in changing the way Medicaid is funded.
The federal Individuals with Disabilities Act requires public schools pay for health care services for students with disabilities — including services like school nurses, speech and mental health therapists. Kentucky schools received $34 million in 2015 toward those costs. Over half of the funds came from Medicaid — the rest came from the state.
That money could be in jeopardy if the American Health Care Act – also referred to as Trumpcare – is revived. The GOP plan proposes cutting $839 billion in Medicaid spending to states over 10 years.
Other changes include funding Medicaid through block grants, which would give states a chunk of money each year to pay for the program. Critics say block grants wouldn’t take into account unexpected public health crises — like a hepatitis C breakout, for example — and it would be up to states to fill in gaps or not.
Brad Hughes with the Kentucky School Boards Association said if federal funding goes away, schools would still be required to pay for health care services for students. He said that could be done by raising taxes or tapping into school general funds that provide other services.
“It could be a devastating unfunded mandate on public schools,” Hughes said. “Then they have to figure out how to pay for it.”
Public schools receive money from the federal government to help pay for health care for children with disabilities but the money also benefits children without disabilities. That’s because if a school nurse is hired, all students at that school likely have access to that nurse.
Having school nurses and other health care professionals in schools also saves money. That’s because when children seek health care at school, parents don’t have to pay co-pays for a doctor’s visit. For parents of children in Massachusetts schools in 2009, those medical costs were valued at $20 million. That’s according to a 2014 study in the Journal of the American Medical Association.
Terry Brooks with Kentucky Youth Advocates said the potential cuts would come to a state that already doesn’t allocate many resources to children’s health care in schools, even though there is a link between education success and health.
“In Kentucky, a real focus on school-based health is very rare,” Brooks said. “It usually boils down to a superintendent who’s thoughtful about the intersection of health and education, and they go to work on making it happen. If we know it’s an idea that’s delivering good services for kids and it’s a win-win, to threaten that is bad economics and bad for kids.”
The cuts could also come as Gov. Matt Bevin makes changes to Kentucky’s Medicaid program. Bevin has proposed monthly payments for all Medicaid recipients, no matter their income, excluding pregnant women and people with disabilities.
That’s concerning to Brooks. He said when parents are insured, they are more likely to also have their children insured. Over 400,000 people gained access to Medicaid through the state’s expansion in 2014.
Kentucky could make up the difference for schools and help them pay for health care for students but Brooks said advocates won’t know what Bevin’s budget priorities are until he unveils his next budget in 2018.