Senate fast tracks Medicaid to Schools fix

New Hampshire Union Leader

Jan. 30--CONCORD -- The State Senate passed legislation Thursday aimed at preserving up to $29 million in federal Medicaid reimbursements to local school districts threatened by new federal guidelines.

The measure (SB 684) speeds up state certification of professionals needed for these schools to get 50% payment to low-income children including those with special needs or kids from families with a history of substance abuse.

After brief debate the Senate passed the legislation on a voice vote with no dissent and it heads to the House of Representatives for its review.

State Sen. Jay Kahn, D-Keene, said the federal guidelines and then state emergency rules adopted in response put at risk grant money to cover 50% of the services by school psychologists, mental health counselors and speech and language specialists who total more than 500 professionals working in 171 of the state's 176 school districts.

These professionals provided services to 11,000 children, Kahn said.

"SB 684 provides a pathway for school professionals being additionally licensed by health related professional licensing boards," Kahn said in a statement.

"We are acting on an accelerated schedule to help schools recover up to $29 million of reimbursement blocked by the Sununu administration's emergency rules."

Last month, Sununu signed an executive order directing 15 health care licensing boards to speed up the certification for these school professionals and he called on the Legislature to approve Kahn's bill (SB 684) that has bipartisan support.

The Medicaid to Schools program, which has been in place for three decades, makes some services in the classroom eligible for 50% reimbursement from the federal government.

Controversy ensued 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 -- mainly students with special needs.

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 had expanded the program.

The federal Centers for Medicare and Medicaid Services advised schools had to be treated like any other health care setting, so all the professionals providing these services in the schools had to be licensed health care providers.

Sen. Jeb Bradley, R-Wolfeboro, praised legislators from both parties and Sununu for acting quickly in hopes of getting this bill onto the governor's desk before the March town meeting season.

"At a time when there is a lot of polarization, we need to recognize a lot of people in this room," Bradley said.

"There is an urgency to getting this done."

Kahn agreed there's been consensus to solve the problem.

"The finger-pointing on this has been really minimal. The attitude has been let's drop the argument and let's just get to it," Kahn said.

Senate Majority Leader Dan Feltes, D-Concord, said Sununu should rescind the rules the Health and Human Services Department adopted last August in response to the federal government and await signing this new law.

"The disruption was the administration's emergency rule. If the administration rescinded the emergency rule while this rewrite is going through the process, wouldn't we be better off?" asked Feltes, a 2020 Democratic candidate for governor.

Bradley said it was the federal government's action and not the state's answer that created this mess.

"The cause of the disruption were the new CMS guidelines implemented on July 1 last year," Bradley said.

"This triggered the state to adopt rules so we were in compliance with those guidelines."

During a telephone interview Thursday, Lisa English, a senior policy analyst with HHS, said getting rid of the rule right now would not help matters.

"Rescinding the rule would not resolve the problem. Absent the rule, anybody who billed for Medicaid without a provider's approval would not get reimbursement. That's where we would be," English said.

State Medicaid Director Henry Lipman said the state also will seek an amendment to its Medicaid plan from the Trump administration that will make eligible for reimbursement to schools the administrative cost of filing for Medicaid claims, along with services of personal care attendants and rehabilitative specialists.

Lipman said even with these changes it's possible some school districts will not get as much reimbursement under this program as they did before these new federal rules.

In 2019, Nashua schools received the most, nearly $2.6 million followed by Manchester at $2.3 million, Rochester with $1 million, Concord with $780,000 and Claremont with $700,000. Merrimack, Keene, Salem and Londonderry each received more than $500,000 last year.