Cuts to Medicaid would affect special needs students across St. Louis region

Aug. 01--ST. LOUIS -- Amid the national noise about potential cuts to Medicaid, some school administrators are trying to bring attention to one arguably lesser-known group that would be affected: their students.

That's because public schools don't just provide education for children. As required by federal law, they also spend hundreds of millions on an array of expensive medical services for thousands of students with special needs, whether it be private-duty nursing, personal care attendants, physical therapy, speech therapy or occupational therapy.

Schools also use Medicaid to pay for school nurses and provide services for students from low-income families, including counseling, health screenings and asthma management.

Under the 1975 Individuals with Disabilities Education Act, public schools are required to provide the services that are needed for students, regardless of disabilities, to come to school. A March U.S. Supreme Court decision reinforced that such educational services must be "ambitious" and of more than just bare-minimum quality.

For some schools, special education means supporting students who come to class on life support or hooked up to oxygen tanks, said Kimberly Ratcliffe, director of the Medicaid Consortium for the Missouri School Boards Association. Some students need to be tube-fed, have diapers changed or have medical procedures done at school.

"Children have so many dreadful health conditions that they have to live with," Ratcliffe said. "They shouldn't have more restrictions than their health is already imposing."

In recent weeks, Republicans in Congress had named Medicaid as a potential target for cuts as they repeatedly tried to repeal former President Barack Obama's signature health care law. The Senate's latest attempt to repeal portions of the Affordable Care Act failed early Friday, but broader bipartisan efforts at health care reform and possible Medicaid changes could come down the road.

Though Medicaid makes up a small fraction of federal money that public schools receive, it's considered a vital funding supplement for schools to provide federally mandated special education services.

That's because the federal government does not, nor has it ever, given states all the funding required for schools to provide mandated special education services.

Ratcliffe said studies show it costs twice as much to educate students with special needs than students without disabilities.

"The money that we're getting through Medicaid is helping to offset the cost," Ratcliffe said. "They don't begin to cover the cost."

At least $20 million from Medicaid goes to Missouri school districts, which educate about 128,400 students from ages 3 to 21 who receive special services. The amount Missouri districts typically receive can be tens of thousands of dollars or as much as a few million.

The most goes to St. Louis Public Schools, which educates about 3,300 students with an Individualized Education Program, meaning they receive special education services. The district received $4.4 million in Medicaid during the 2015-2016 year.

About $2.4 million in Medicaid went to Special School District, which educates students with special needs and provides services for 22 St. Louis County districts. Special School District uses those Medicaid dollars to serve about 9,700 students across St. Louis County who are Medicaid-eligible, said Nancy Ide, district spokeswoman.

Nationwide, more than $4 billion in Medicaid goes to schools, or roughly 1 percent of all Medicaid.

Brent Ghan, deputy executive director for the Missouri School Boards Association, estimates about 350 of Missouri's roughly 520 school districts receive Medicaid. That number doesn't include districts that have Medicaid-eligible children but don't file for the funding. Some school officials may think there are too few eligible children to be worth filling out paperwork, Ghan said.

That number also doesn't include charter schools, which also benefit from Medicaid. For example, Confluence Charter Schools, the largest charter school network in St. Louis, received about $262,000 in Medicaid in 2015.

Compared to children with special needs who don't receive Medicaid, children who do miss fewer school days due to illness or injury, perform better in school and are more likely to graduate high school and attend college, said Elisabeth Burak, senior program director of Georgetown University's Center for Children and Families. Meanwhile, sick children are more likely to miss school, drop out and have weak social skills.

"Whenever they're facing health issues that are not addressed, it has a definite negative impact on their ability to learn," Ghan said.

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