BILL NUMBER: S7840

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to coverage for
services provided by school-based health centers for medical assistance
recipients

 
PURPOSE OR GENERAL IDEA OF BILL:

To permit school-based health centers (SBHC) to remain out of Medicaid
managed care.

 
SUMMARY OF SPECIFIC PROVISIONS:.

Section 1 of the bill amends Social Services Law § 364-j relating to
managed care programs, to provide that school-based health center (SBHC)
services remain carved out from Medicaid managed care.

Section 2 of the bill establishes an effective date.

              

 
JUSTIFICATION:

School-based health centers (SBHCs) provide comprehensive physical,
chronic, mental, and dental health services to over 230,000 underserved
youth in rural, urban, and suburban areas of the State, regardless of
insurance status or ability to pay. SBHCs are a proven model for
increasing access to health and mental health services, reducing ethnic
and racial disparities in the communities they serve, and improving
school attendance and performance. They have a proven track record of
reducing healthcare costs by offering preventative care and an alterna-
tive to unnecessary hospitalizations and emergency room visits.

Since 1985, SBHCs have been "carved-out" of the Medicaid managed care
program, being paid under fee-for-service. However, the Department of
Health (DOH) has repeatedly attempted and then delayed ending the carve-
out, with the most recent delay having ended on April 1, 2023.  This
means that SBHC services could be transitioned to a managed care model.

If carved in, SBHCs will be required to negotiate the terms and condi-
tions of payment through managed care plans, with prior authorization
and utilization review, delaying care for New York children who rely on
these centers and adding to their administrative burdens. Already, SBHCs
have suffered from nearly 30% in cuts to funding since 2008, though
their patient population has grown. This bill ends the years of attempts
and delays by making the carve-out permanent and providing stability to
this vital public health service.

 
PRIOR LEGISLATIVE HISTORY:

2023: S2339 (Rivera) - Vetoed Memo 58

2022: S8447 (Rivera) - Vetoed Memo 154

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.