N.H. Schools Not Yet Receiving Expanded Medicaid Funds

Last August the New Hampshire legislature passed a bill that would allow schools to be reimbursed for part of the costs associated with things like speech therapy, mental health counseling and nursing for all students who qualify for Medicaid.

Previously that reimbursement was only available for some students who qualify for Medicaid. But schools are not yet taking advantage of this additional federal money. 

Rebecca Whitley, policy coordinator for the New Hampshire Children's Behavioral Health Collaborative, an advocacy organization, spoke with NHPR's Peter Biello about the expanded Medicaid program.

What kind of students would benefit from this program?

The expansion of the Medicaid to School program would benefit all children who are Medicaid eligible in schools that have medical needs. So this could cover services such as occupational and physical therapy, psychological and health services, nursing, speech, language, and hearing services, any type of medical need a Medicaid eligible student might need. 

Do you know why the state is not really ready to take advantage of this expanded program, the so-called Medicaid to Schools program? 

I don't. I think you'll have to speak with the department to sort of understand why they haven't fully implemented this law. 

What was your expectation based on what the state had said? Should it be in place now?

It should be. The expectations are clearly laid out in the law. The Senate Bill 235 specifically directed the state to start the rulemaking process in September 2017 and that is a formal rulemaking process under state law.

So they said they started by that starting date but they just haven't wrapped it up yet. The hope is that they would wrap it up soon but it seems like the state is saying it won't be ready until mid-fall at the earliest, yes?

I'm not quite clear whether formal rulemaking has started. I haven't seen a proposed rule quite yet.

What is the impact of the state's failure to put this in place for this upcoming school year?

It's really difficult to estimate the exact amount of federal dollars that have been left on the table but there's no question that substantial federal dollars to support financially strained school districts have been permanently lost.

Does this mean schools are not offering certain services to students or that they're just not offering as much of that service or being reimbursed as much as they normally would be? 

There are some school districts that are already providing these services, particularly larger school districts with larger budgets but they're not able to capture the 50 percent match from the federal dollars. So there are some school districts that are paying 100 percent of the cost of these services when they could access federal dollars to support half of those services. And there are some school districts, smaller school districts perhaps, that aren't able to offer these services at all because of the cost. The expansion of this program would allow these school districts to start offering these supports to students. 

Why is it important for schools to take advantage of this?

I think particularly now our state is grappling with mental health and substance use crises. The delay in implementation has lost all these federal dollars that a lot of financially strained school districts really want to provide, hope to support children and their families.

What's the next step for you? Are you advocating and pushing for this with the Department of Education or DHHS?

Absolutely. We've been in touch with the Department of Health and Human Services to start to understand the reasons for the delay and how we can be supportive. But we're just not quite sure the source of the delay. 

We reached out to the state Department of Health and Human Services to clarify why this program won't be in place by the beginning of this school year. DHHS did not respond by airtime, but later provided the following statement:

"The Medicaid to Schools (MTS) program is a voluntary program that allows schools to bill Medicaid for services provided to students who have an Individualized Education Plan (IEP). Recent legislation expanded MTS to allow children without an IEP to receive services and to increase the array of behavioral health services eligible for reimbursement by Medicaid. While initial required rulemaking was completed last year, DHHS could not move forward with adopting rules to implement expanded services until the Centers for Medicare and Medicaid (CMS) approved a new state plan amendment. That approval was received in July.  DHHS is moving forward with adopting rules for expanded services and, as directed by the Governor, is exploring all options available to see what can be put in place by the start of the school year.”

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