House Trumpcare Bill Guts Medicaid Funding Used by Public Schools to Pay for Special Education

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.


Budget Agreement Protects Title I, IDEA, Head Start, and Impact Aid for Indian Reservation Schools

Budget agreements may seem far away and deep in the policy weeds, but they cut through the rhetoric and posturing to point the direction where things are actually going to go.  Last night, January 13, House and Senate agreed on a federal spending compromise for the rest of the fiscal year—through September.  Assuming that Congress passes what the negotiators decided, the education spending provisions are a relief for supporters of public schools.

According to Alyson Klein, who covers federal policy for Education Week, the Title I formula program that allocates federal funds to support school districts that serve a large number or high concentration of poor students and the Individuals with Disabilities Education Act (IDEA) will receive increases, almost reaching the level before Sequestration reduced their funding.  Title I will get $14.4 billion, slightly under the $14.5 billion it received in FY 2012.  Special education grants will be $11.5 billion, just slightly less than the pre-Sequestration, FY 2012 amount of $11.6 billion.  Keep in mind that both of these programs have been perennially under-funded.  When Congress passed IDEA, for example, the federal government promised to pay scho0l districts 40 percent of the costs of implementation; Congress has never covered more than 19 percent of the cost— and usually less than 19 percent.  However, this year it is a relief to see Congress pretty much undoing the damage of Sequestration to these programs that cover essential programming in schools across the country at a time when state budgets continue to be austere.

While Congress will fund—at $250 million—another round of Race to the Top early-learning competitive grants for states, Congress does not intend to allocate $750 million that the President had requested for development grants to states to expand preschool programs for 4-year-olds. The choice not to fund the President’s pre-school initiative will be a disappointment for all who know the importance of early education.

However, Congress has agreed to boost Head Start by $1 billion, bringing that program’s allocation back up to $8.6 billion, with $500 million of that going to strengthen early Head Start.  Head Start had been devastated by Sequestration, which eliminated 57,000 children from participation last year.  Additionally Congress will allocate $$2.4 billion for Child Care and Development Block Grants,  adding $154 million over last year’s investment in this program that helps states support child care assistance for families in need.

Public schools on already poor and isolated Indian Reservations have been devastated by Sequestration’s cuts to Federal Impact Aid.  The new budget agreement adds $64 million over last year’s appropriation to bring Impact Aid spending to $1.3 billion.

Congressional budget negotiators did not include funding for the President’s request for $1 billion in “Higher Education Race to the Top” competitive grants to motivate states to create accountability at the college level for raising graduation rates while holding down tuition.

The spending agreement also significantly revises the competitive School Improvement Grants (SIG).  Congress has removed the requirement that schools choose from among very controversial, prescribed “turnaround” plans: firing the principal and half the staff, closing the school, turning the school over to a charter management or educational management organization, and implementing other specified reforms such as merit pay or lengthening the school day or year.  The language in the spending agreement would, according to Alyson Klein in Education Week, “offer schools and states two new choices including the chance to try out any school improvement strategy that’s been proposed by the state and gotten a green light from the U.S. Secretary of Education,” or a fifth model, “‘whole school reform,’ which would allow schools to partner with an outside organization that has a proven track record in turnarounds.”  Klein describes Congressional revision of SIG as “a blow to the Obama administration, which had stood stubbornly behind its four models, even as student outcome data from the SIG program showed it had a mixed track record.”

Budget negotiations are one place where we all need to be very grateful for the inside-the-Beltway groups that represent the interests of teachers, principals, superintendents, school boards, and the children they serve.  Here is how NEA describes the priorities NEA and its partners pushed for: “To help mitigate the damage, this week NEA joined the American Federation of Teachers, American Association of School Administrators, Council of the Great City Schools, and National Schools Boards Association in urging the appropriators crafting the Labor-HHS-Education and other funding bills…  to make undoing the cuts in core formula grant programs that benefit students most in need, like Title I and IDEA, a top priority.”