Commentary: This administrative change would hurt children's health care access
Originally published in
Albany Times Union
on
.
School-based health centers shouldn't move to Medicaid managed care. It will hurt care and increase costs
In less than 30 days, school-based health centers are set to transition into Medicaid managed care, following a September 2024 state directive. This transition threatens the viability of this essential child safety net, and we urge Gov. Kathy Hochul to stop this April 1 transition and keep school-based health centers in the Medicaid fee-for-service model.
The 250 school-based health centers throughout the state provide basic health care for over 250,000 children and adolescents in our most underserved communities, including primary, dental, mental health, vision and reproductive health care services. They provide unparalleled access to care because they meet children where they spend much of their days — in schools. This helps to keep kids healthy and in school while increasing academic progress and graduation rates.
The overwhelming majority of children served are enrolled in Medicaid, and school-based health centers have always been carved out of the Medicaid managed-care program, enabling them to receive reimbursement directly from the state through Medicaid fee-for-service.
The health centers do not have the resources or administrative support to be in Medicaid managed care. They have no leverage with health plans, given their mission and mandate to see all children who walk through their doors. And considering the condensed timeframe and lack of stakeholder engagement, trainings and readiness assessments by the state, it is basically impossible for school-based health centers to comply this this mandated transition. What’s more, unresolved issues threaten access to care for our most vulnerable youth, including ensuring confidentiality when receiving reproductive health care and mental health care.
A recent Connecticut report found that its current fee-for-service model was more cost-effective, with less than 4% of Medicaid expenditures going to administrative costs, compared with almost 10% on average by states with managed care. Further, the JAMA Health Forum released a report in 2024 that looked at the relationship between Medicaid managed care for dental services and pediatric dental emergency department visits in Florida. The report found that the state saw an 11.3% increase in the number of pediatric emergency department visits for nontraumatic dental conditions after shifting to managed care, suggesting Medicaid managed care may reduce access to dentists.
Not only would moving school-based health centers to Medicaid managed care not save the state money, it would increase costs, since the state would need to pay health plans to administer the benefit. Also, there is no proof that such a shift would improve care or outcomes for vulnerable youth. To the contrary, it will result in a loss of critical care for children who have no other access.
We strongly urge the governor to reconsider this move. We must do everything we can to protect school-based health centers and their ability to provide the critical care that our most underserved children so badly need.
Assemblymember Amy Paulin of Scarsdale represents the 88th Assembly District and serves as chair of the Assembly Health Committee. State Sen. Gustavo Rivera of the Bronx represents the 33rd Senate District. He’s the chair of the Senate Health Committee.