NH scrambles to avoid losing millions from feds for Medicaid services in schools

Oct. 2--CONCORD -- The state has created an emergency rule to avoid the threatened loss of millions in federal funding over how New Hampshire delivers Medicaid services in public schools.

Gov. Chris Sununu wrote to local school officials to assure them the state is revamping the program in compliance with guidance from the federal Center for Medicaid and Medicare Services.

"Over the past several weeks, my office has heard from many school districts who are concerned about federally-required changes to the Medicaid to Schools Program," he wrote. "I share those concerns and directed Health and Human Services Commissioner Jeff Meyer to dig into the issue and provide school districts with background and guidance on the situation."

The Medicaid to Schools program has been in place for nearly two decades and it makes some services in the classroom eligible for 50 percent reimbursement from the federal government.

Controversy emerged after the Legislature greatly expanded the number of students who could be eligible for these services. Previously, only students with needs documented by an individualized education plan qualified, largely students with special needs.

But in 2017, Sununu signed a state law that allowed any student who comes from a family receiving Medicaid health insurance to be eligible.

Medicaid insurance is offered to low-income families, the disabled and families with senior citizen members.

Last spring, federal officials alerted Department of Health and Human Services there were flaws in how the state was expanding the program.

"CMS clarified that schools are simply a setting in which Medicaid coverable services may be delivered," Meyers said in his memo on the topic "Thus, all Medicaid requirements must be met in order for the services to be reimbursed through Medicaid including the requirement that a provider is a qualified treatment provider...as well as the requirement that the service is consistent with the state plan or coverable under Early Periodic Screening Diagnostic and Treatment."

In late August, HHS filed an emergency rule now in place to make the changes federal officials outlined.

Meyers said his agency will create a public work group with all stakeholders to work with federal officials to close the gaps between qualified treatment providers and school professionals who have the skills to provide such services.

"This work may include amending the state plan, seeking legislative changes and working with New Hampshire licensing boards," Meyers wrote.

The agency had to make these changes or both state and local governments faced the prospect of bad outcomes, he said.

"Again, absent immediate action by the department, the state and local districts would face increasing liability that may result in the recoupment of millions of dollars and harsh penalties for the state," Meyers warned.

"Nevertheless, we recognize the challenges this presents, and we look forward to working collaboratively with all involved to remove any barrier to ensuring children in the program receive the medical services they need."

Sununu said he'll be working with the Trump administration to ensure local districts are getting as much financial benefit out of this partnership as is legally possible.

"I will be reaching out directly to CMS to explore opportunities which would allow us to take action to provide for greater flexibility and responsibly expand reimbursement opportunities," Sununu said.

"My goal is to ensure students are getting the services they need without risking federal funding for the program."

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