School-based health centers are sounding the alarm about a recently announced plan to change the way they get paid by the state’s Medicaid program. The Hochul administration notified the centers in late September that their health services will be carved into Medicaid managed care starting April 1, meaning they will no longer bill Medicaid directly on a fee-for-service basis. Instead, they will have to ink contracts with private insurers that administer New York’s Medicaid program. The transition isn’t exactly a surprise — it was initially scheduled for 2014, but the carve-in date was pushed back seven times, according to the New York School-Based Health Alliance. The most recent delay was this past April. For a minimum of two years following the shift, Medicaid managed care plans will be required to pay school-based health centers no less than the fee-for-service rates they now receive. But the centers could still end up in the red, advocates say. “The administrative burden would be way too high, and these are centers that are already providing services without much financial support,” Adria Cruz, deputy director of health programs and integration for Children’s Aid, said in an interview. Children’s Aid, a nonprofit, runs six school-based health centers in New York City. Cruz said an internal review projects the transition would result in a 30 percent to 40 percent hit to the organization’s school health services revenue. There are roughly 250 school-based health centers statewide offering a range of primary care, preventive care, oral care, mental health care and reproductive health services — from annual physicals and vaccines to mental health counseling — regardless of students’ ability to pay. Most of the 250,000 students served by school-based health centers are enrolled in Medicaid or uninsured, according to 2022-2023 data. State lawmakers approved legislation this year to keep school-based health centers permanently carved out of Medicaid managed care. The bill’s backers include 1199SEIU, the Greater New York Hospital Association and the Healthcare Association of New York State. Sen. Gustavo Rivera, who chairs the Senate Health Committee and sponsored the bill in his chamber, said he is “deeply concerned” about Gov. Kathy Hochul’s decision to move ahead with the transition despite the Legislature’s unanimous approval of his bill. “We can address issues with the program without dismantling the current funding structure that effectively supports it,” he said in a statement. “I am urging the Hochul administration to come to the table to find a path forward that doesn’t jeopardize access to health care at schools for New York’s most vulnerable children.” Even the New York Health Plan Association, which represents managed care plans in the state, favors the current setup. “We recognize the unique relationship between school-based health centers and their provider sponsors, and the services they provide,” association president Eric Linzer said in a statement to POLITICO. “This current structure does not lend itself to the care coordination practices that health plans rely on and transitioning from the current fee-for-service system would create massive disruption for providers, schools, children and families, and is the reason we support the legislation to maintain the current process.” While Hochul included a 10 percent Medicaid rate hike for school-based health centers in last year’s state budget — a $1.4 million investment — the increase is still pending approval by the Centers for Medicare and Medicaid Services. In response to a request for comment, the Department of Health did not directly address the school-based health centers’ concerns about the upcoming change. “The transition of school-based health centers into the Medicaid managed care benefit package will strengthen and improve the coordination of care, quality of care, and outcomes for children,” department spokesperson Erin Clary said in a statement. IN OTHER NEWS: — The families of two women who died in childbirth, Bevorlin Garcia Barrios and Christine Fields, joined the New York State Trial Lawyers Association for a rally outside NYC Health + Hospitals/Woodhull in Brooklyn on Friday, calling on Hochul to sign legislation that would update the state’s wrongful death statute. The Grieving Families Act passed the Senate and Assembly again this year with bipartisan support, despite previously being vetoed by Hochul. It would amend a 170-year-old statute that bars families of loved ones from receiving compensation for their emotional loss. The current law allows families to be awarded pecuniary losses only. ON THE AGENDA: — Tuesday, 10 a.m. to 3 p.m. The Opioid Settlement Fund Advisory Board meets. — Wednesday at 10:30 a.m. The New York State Board of Examiners of Nursing Home Administrators will meet in public session. MAKING ROUNDS: — Bill Hicks, CEO of NYC Health + Hospitals/Bellevue, last week announced he plans to retire. He will be succeeded by Health + Hospitals’ senior vice president and chief quality officer Eric Wei, effective Jan. 6. GOT TIPS? Send story ideas and feedback to Maya Kaufman at mkaufman@politico.com and Katelyn Cordero at kcordero@politico.com. Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories.
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