Times-Union: Will New York’s school health centers survive Medicaid change?

November 1, 2017

ALBANY — The number of New York public schools with on-site health centers has nearly doubled in the past two decades, with data showing benefits to both student health and academics.

But a looming change in the way these centers are reimbursed for Medicaid patients could cause them to scale back services or close altogether, officials warned Tuesday at a news conference in the Legislative Office Building.

State legislators and health and education leaders called on the governor to sign legislation that would halt the change, by granting school-based health centers a permanent “carve-out,” or exemption, from the state’s Medicaid Managed Care program.

“Forcing school-based health centers into Medicaid managed care plans will wreck a model that works,” said Assembly Health Chair Richard Gottfried, who co-sponsored the legislation with Sen. James Seward.

The centers have received a carve-out for years on the grounds that shifting to managed care plans is too great an administrative burden. The exemption is set to expire on July 1, 2018.

Under the current system, school-based health centers are paid directly by the state Medicaid program for each service provided. Starting in July, however, they will be required to negotiate the terms and conditions for reimbursement with the students’ health plans directly. That could put 252 centers, including three centers in Albany, two in Schenectady, two in Middleburgh and one in Lake Luzerne, serving more than 200,000 children around the state at risk of reduced payments and increased administrative costs, advocates say.

“If it ain’t broke, we probably don’t need to fix it,”said David Shippee, president and CEO of Whitney M. Young Jr. Health Services, which oversees centers at Giffen Memorial Elementary School, Philip Schuyler Achievement Academy and Sheridan Preparatory Academy in Albany.

The centers differ from an average school nurse’s office in that they provide a wide range of services from flu shots, annual physicals and immunizations to dentistry, mental health counseling and chronic illness management, and they are typically run by hospitals or medical practices.

They’ve become increasingly popular as a method of boosting school attendance. Students who receive their health care right in school are less likely to miss school and show up late, and more likely to seek out help for mental health issues.

A study by Johns Hopkins University found reduced hospitalization and inappropriate emergency room use among regular users of school-based health centers. A study by Emory University found the centers were responsible for a reduction in Medicaid expenditures related to inpatient, drug and emergency department use.

The legislation to grant a permanent Medicaid managed care carve-out passed both the Senate and Assembly this June, and is awaiting a signature from the governor, whose office did not respond Tuesday to a request for comment.

It is supported by the New York School-Based Health Alliance, Greater New York Hospital Association, New York State United Teachers, the United Federation of Teachers and the New York State School Boards Association.