President Donald Trump and members of the House of Representatives celebrated after the House passed the new Trumpcare bill last Thursday. But there is much in the new law not to celebrate, including this: Tucked into the bill is a little-noticed cut in Medicaid funding for the expensive services school districts are required to provide under the Individuals with Disabilities Education Act (IDEA) for students who need speech and language therapy, occupational therapy, medical services, or specialized school transportation.
Here is Stephen Koff, the Cleveland Plain Dealer‘s Washington Bureau Chief: “Ohio schools could lose millions of dollars they now get to pay for speech and physical therapy, behavioral services, student evaluations and other special education services, because of changes to Medicaid in the congressional bill to repeal and replace Obamacare. The money assists about 61,000 students in 580 Ohio school districts. In 2013, the last year for which final figures are available, the federal government sent Ohio schools an estimated $47.25 million for the program.” That is merely what Medicaid paid that year for necessary services in one of the 50 states.
Here is Erica Green for the NY Times: “School districts rely on Medicaid, the federal health care program for the poor, to provide costly services to millions of students with disabilities across the country. For nearly 30 years, Medicaid has helped school systems cover costs for special education services and equipment, from physical therapists to feeding tubes. The money is also used to provide preventive care such as vision and hearing screenings, for other Medicaid-eligible children.”
Green explains that the bill the House passed last week to repeal and supposedly replace the Affordable Care Act “would cut Medicaid by $880 billion, or 25 percent, over 10 years and impose a ‘per-capita-cap’ on funding for certain groups of people, such as children and the elderly—a dramatic change that would convert Medicaid from an entitlement designed to cover any costs incurred to a more limited program.”
Stephen Koff explains the problem in plainer language: “(T)he bill… would change Medicaid, a joint federal-state program for low-income Americans that expanded under Obamacare, and lead to a cut in Medicaid funding. Unknown to many Americans, Medicaid helps support special education programs in schools. The Medicaid in Schools program helps pay for services to children with an Individualized Education Plan (IEP), ‘including but not limited to behavioral health, nursing, occupational therapy, targeted case management and specialized transportation,’ state documents say.”
A report last week for the Center for American Progress explains: “Part B of the IDEA guarantees children ages 3 to 21 access to special education services in their public schools… (F)unding for Part B falls well below the cost for services, and school districts use a combination of other local, state, and federal funding sources to meet children’s needs… Each year, school districts collectively rely on $4 billion to $5 billion in Medicaid funds to support special education services for children eligible for Medicaid. Schools use these funds to pay critical personnel such as speech-language pathologists and occupational therapists, as well as to provide assistive technology and transportation for children with special needs. Many schools also provide developmental screenings to students through Medicaid….”
In the Plain Dealer, Koff quotes a statement released by Ohio Senator Sherrod Brown: “Whatever your opinion of the Affordable Care Act, we should all agree that forcing schools to choose between laying off special education therapists that students depend on and increasing class sizes or reducing AP and elective classes for other students is wrong.”
The U.S. Senate will soon be considering Trump’s request to repeal and replace the Affordable Care Act. Although in March and April, as the House of Representatives prepared to consider a healthcare plan, some advocacy groups did raise concerns about threatened cuts in essential special education services paid for by Medicaid, many of us have remained unaware of the problem. Please become conversant with the issues described in this post, inform your colleagues and friends about this serious matter, and be prepared to speak with your U.S. Senators when the healthcare law debate reaches the Senate.