Dive Brief:
- A proposed U.S. Department of Education rule intended to streamline the process of obtaining parental consent for Medicaid school-based health services has garnered about 9,700 comments — both from supporters saying the change could help expand health services and those in opposition who said it would limit parents' rights.
- The proposed rule, issued in May, is recommending a rare amendment under the Individuals with Disabilities Education Act, which guarantees supports for students with disabilities for learning and related services. No other parental consent procedure under IDEA would be impacted.
- Reimbursements for the cost of school-based Medicaid services are the third or fourth largest revenue source for schools. However, the current parental consent process puts additional paperwork burdens on staff, and many parent consent forms remain incomplete, school administrative groups said.
Dive Insight:
The proposed rule specifically seeks to eliminate an IDEA provision that requires one-time parental consent before schools file first-time invoices for school-based specialized services for children eligible for public benefits under Medicaid, the Children’s Health Insurance Program, or other public insurance and benefits programs.
Many children with disabilities eligible for IDEA are also enrolled in Medicaid due to their disability status or based on their family income. Children with disabilities and special healthcare needs are more likely to be low-income, and those covered by Medicaid are more likely to have greater healthcare needs than those covered by private insurance, the proposed rule said.
School-based Medicaid-eligible services for students with disabilities, for example, could include speech therapy and physical and mental supports. The proposed rule said both students with disabilities who are eligible for public insurance benefits and those who aren’t will continue to receive their free individualized education program services regardless of a school’s costs for the services or access to reimbursement.
Additionally, a school's parent consent form must include that the Medicaid billing for school-based services would not impact lifetime coverage or any other insured benefits.
If the proposed rule is finalized, parents would still give their consent for Medicaid providers, including schools, to access public benefits for billing purposes when enrolling a child or themselves in Medicaid.
But because parents are currently asked to provide consent at both these points, it leads to confusion, said Jenny Millward, executive director of the National Alliance for Medicaid in Education, or NAME.
"We find that parents are just so confused about the duplicity of this requirement," Millward said. Although NAME works as a neutral organization that focuses on providing Medicaid-related resources to schools, it was one of the co-signing organizations in a letter of support, led by the Council of Administrators of Special Education, for the proposed rules.
A 2022 survey of school district leaders and Medicaid administrators found that a third of survey respondents said 26% to 50% of their Medicaid parental consent forms are not complete.
"We do strongly feel that this is a move towards improving and enhancing the access that children will have to receiving services, because we all know that kids are six times more likely to receive services when they can access them at school," Millward said.
Some commenters, however, voiced concern that the change would expand school-based health centers, bypass parental consent outreach, or negatively impact public insurance benefits.
The American Speech-Language-Hearing Association, in a letter, said that while the professional organization appreciates the Education Department's focus in this area, it finds the proposed rule "problematic" because it could inadvertently impact services students may receive outside of the school setting.
"Allowing a school district to unilaterally authorize billing for Medicaid without full knowledge of the child’s complementary needs outside of a school setting will negatively impact a child’s ability to receive the highest quality comprehensive services possible," the letter said.
The Education Department is planning to release a final rule in January. When the Education Department issued the proposed rule, it also released long-awaited guidance for school-based Medicaid services and billing.
Meanwhile, a tracker from the Kaiser Family Foundation shows that between this spring and Dec. 13, 2023, at least 2.4 million children had been disenrolled from Medicaid out of 6.2 million total disenrollments in the 21 states reporting age breakouts. KKF said data is limited but estimates that children account for four in 10 Medicaid disenrollments. The foundation also said a majority of disenrollments were due to procedural reasons.
This Medicaid "unwinding" comes as public insurance programs transition from pandemic-era automatic renewals. The Centers for Medicare and Medicaid Services released a toolkit for schools to help families retain their benefits. The toolkit, for example, encourages schools to send communications to parents urging them to update their contact information with their state Medicaid and CHIP program and respond to renewal notices.
