WASHINGTON --Ohio schools could lose millions of dollars they now get to pay for speech and physical therapy, behavioral services, student evaluations and other special education services, because of changes to Medicaid in the congressional bill to repeal and replace Obamacare.
The money assists about 61,000 students in 580 Ohio school districts. In 2013, the last year for which final figures are available, the federal government sent Ohio schools an estimated $47.25 million for the the program.
Based on a formula for the healthcare bill that the House of Representatives approved in a narrow vote this afternoon, Ohio schools would collectively lose $8 million to $12 million a year to pay for this Medicaid in Schools program if the bill became law.
Large districts like Cleveland Metropolitan School District would lose more than $500,000 a year, enough to pay the salaries of a number of special education teachers, therapists or nurses.
Bigger or smaller cuts are possible. States would have to decide whether to dedicate more or less money to other health programs -- such as health coverage for low-income Ohioans -- or make the schools absorb the loss.
One thing would not change, however. Schools would still be required to provide these services, such as speech and motor-skills therapy, assessments and transportation to schools or other specialty centers, under the federal Individuals with Disabilities Education Act, or IDEA.
It was unclear if members of Congress voting on the bill -- a broad measure to repeal and replace the Affordable Care Act, or Obamacare -- knew this level of detail.
They planned to vote without having full information on the bill's costs or its overall effect on
health coverage, details that the Congressional Budget Office is still assessing after a recently proposed amendment changed an earlier version of the bill.
Supporters have said they have a general sense of what the bill would do. They want to end or roll back some of Obamacare's federal mandates and give states and insurers more authority and flexibility in health coverage. President Donald Trump pushed for the vote.
Rolling back the mandates and changing the structure of Obamacare's taxpayer subsidies could bring down insurance premiums for some people, although not for all. This could also result in less comprehensive health coverage, but proponents say consumers should have the right to buy the coverage they want.
Yet the bill also would change Medicaid, a joint federal-state program for low-income Americans that expanded under Obamacare, and lead to a cut in Medicaid funding. Unknown to many Americans, Medicaid helps support special education programs in schools.
The Medicaid in Schools program helps pay for services provided to children with an Individualized Education Plan (IEP), "including but not limited to behavioral health, nursing, occupational therapy, targeted case management and specialized transportation," state documents say.
In a statement on the potential cuts, U.S. Sen. Sherrod Brown, a Democrat, said, "Whatever your opinion of the Affordable Care Act, we should all agree that forcing schools to choose between laying off special education therapists that students depend on and increasing class sizes or reducing AP and elective classes for other students is wrong.
"Instead of forcing Ohio schools to cut services for our kids, let's work together to lower costs and make healthcare work better for everyone," Brown said.
Advocacy groups and several liberal think tanks say cutting such services would be disastrous. Several think tanks warned of this in March, as did a coalition of groups representing school nurses, psychologists and advocates for people with disabilities, but the broader discussion about ending Obamacare got much more attention. A New York Times story today brought the concern to a wider audience.
The bill would not require states to end this use of Medicaid; it would be up to each state. But the bill would change the way Medicaid gives money to states, resulting in an expected cut. Medicaid money now is sent based on the medical and health care services people use. Congressional Republicans say this is more generous than the nation can afford.
The bill would restrict federal Medicaid funding by using a fixed per-beneficiary average. If states wanted more flexibility, they could take their Medicaid money a different way -- as one big block grant.
Either way, the changes mean states would receive much less money than under the current system. This would force them to make choices about how to use the money. Even if Ohio chose to keep the Medicaid in Schools program -- it is too early to know how that might play out in Columbus -- Ohio would have less money overall for all of its Medicaid recipients. Ohio and all other states would have to re-prioritize.
The House voted 213-217 for the bill. A Senate vote has not been scheduled. Some Senate Republicans including Sen. Rob Portman of Ohio have said already they cannot support the bill in its current form because, they say, it could leave too many currennt Medicaid patients with uncertainty about their care.