Schools will reopen in the next few weeks across New Hampshire without newly available federal money for student services such as speech therapy, mental health counseling and nursing.
The Legislature passed a bill a year ago to expand a program that allows schools to be reimbursed for 50 percent of the cost of providing such services to Medicaid-eligible students. In the past, the Medicaid to Schools program applied only to students with Individual Education Plans under the federal special education law. But after the federal government revised its guidance, lawmakers expanded the program to cover any Medicaid-eligible student with medical needs.
The bill required the state Department of Health and Human Services to start working on the changes by Sept. 1, 2017. Parents and advocates are frustrated that the work remains unfinished heading into the new academic year.
“It’s a significant assistance to public schools, and the only reason it’s not in effect is because of the failure to implement the program as required,” said Michael Skibbie, policy director at the Disability Rights Center of New Hampshire. “We don’t know exactly how much is being left on the table by failing to implement this program, but we think it’s pretty significant. It’s a real problem.”
LeeAnn Bowen of Merrimack has a 9-year-old daughter who is covered by Medicaid and has an IEP. But her 5-year-old son isn’t covered and doesn’t have an IEP. She said she has unsuccessfully pressed the school district to provide services to help with his lack of core strength and other issues. Even if he wasn’t eligible under Medicaid to Schools, she wishes it was implemented so it could free up money for other students.
“I don’t understand why some children get it and some don’t,” she said.
In a letter to the Disability Rights Center and others in May, DHHS Commissioner Jeffrey Meyers said the department “will initiate formal rulemaking early this summer so that this program is in place by the beginning of the 2018-19 school year.”
But Christine Santaniello, director of the Division of Long Term Supports and Services, said a draft amendment to the existing program rules won’t be presented to the legislative committee that must approve changes until sometime in the fall.
The department did meet the Sept. 1 deadline to start the process, Santaniello said, and since then officials have researched what other states have done and have met with school districts and other stakeholders.
“It’s a process, and it’s complicated. We want to do it, and do it right,” she said in an interview. “We’re also doing it within our existing staff resources.”
Santaniello said 63 percent of schools participate in the current program. That resulted in $27.9 million from the federal government in fiscal year 2016, according to the New Hampshire Fiscal Policy Institute.
Skibbie said schools already are providing many of the services, but he also believes there are children who are going without. For example, he said more schools would be able to participate in efforts to better coordinate services between schools and community mental health centers if they had more funding. It’s unclear how many additional students might benefit from the funding.
“It can’t be demonstrated, but I believe there are services that would be provided if schools could just get across the threshold to being able to afford them,” he said.
Rebecca Whitley, policy coordinator for the Children’s Behavioral Health Collaborative, said the expansion of Medicaid to Schools was an important part of the effort to create a comprehensive system of care for children with behavioral health needs.
“Especially at a time when our state is grappling with mental health and substance use crises, the delay in implementation has resulted in the loss of substantial federal funds to support financially strained school districts hoping to support children and their families,” she said.
Janette Plaisted of Rochester has a 13-year-old son who has an acquired brain injury and autism. He is covered by a Medicaid program for severely disabled children, has an IEP and receives counseling, occupational therapy, speech therapy and other services at school. Plaisted said she doesn’t know whether his school bills Medicaid for those services, but hopes the school will offer more to other students once the program is expanded.
“I’m really having trouble getting him the supports he needs, but I’m also conscious of the low budget we have in our city, and I don’t want to take away from other children,” she said.