BILL NUMBER: S1224

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 section 364-j of the Social Services relat-
ing 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, and mental health services to over 250,000 underserved youth in
rural, urban, and suburban areas of the State and an additional 100,000
kids receive essential dental services through SBHCs.  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. Recently, DOH announced the State's intent to move SBHCs under
Medicaid to managed care on April 1st, 2025.

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:

2024: S7840 Rivera/A8863 Palin - Vetoed memo. 81

2023: S2339 Rivera/A6029 Paulin - Vetoed memo. 58

2022: S8447 Rivera/A9288 Gottfried - Vetoed memo .154

 
FISCAL IMPLICATIONS:
None.

 
EFFECTIVE DATE:
Immediately.