Medicaid Morass

The paperwork necessary to "prove" the
the existence of a life long condition
times two.
The Medicaid system is byzantine. There is no way around that fact. Issues with Medicaid have plagued those of us living with disability for decades. But it’s nice to see that others are beginning to notice problems with Medicaid to wit, “The new healthcare bill could worsen the stigma of special education.” Of concern here is the possibility of a loss of $4 billion over the next 10 years earmarked for schools to help children with special needs.
Without Medicaid, support services as well as educational outcomes for children with disabilities may suffer. In a report from January of this year, AASA, the School Superintendents Association, made clear how dire the situation could get. Health and wellness, therapy, and nursing services will be on the chopping block, as will the jobs of staff whose salaries are paid either in part or in full by Medicaid reimbursements.
In a letter sent to top lawmakers on May 2, a non-profit organization comprised of members from the nation's school districts and state Medicaid and Education agencies known as the the [sic] Save Medicaid in the Schools Coalition, purported that nearly 70 percent of school districts use Medicaid funding to employ nurses, psychologists, social workers, and other specialized support staff. That money is also relied on to ensure access to assistive technology and mobility equipment, such as speech to text devices, walkers, wheelchairs, lifts, and therapeutic bicycles.
I don’t know if anyone has been paying attention but children designated as having special needs are already not receiving the services they need. Services mentioned in this opinion article, like therapy and nursing services, are already undersupplied to students in schools. My local school district has a perennial shortage of nursing staff and it’s haphazard whether students receive the appropriate types of therapy. Social workers and psychologists are overworked because there are never enough of them. Parents generally must fight to get and keep support staff in the classroom with their children. Assistive technology and equipment is also hard to come by with the process taking months, sometimes as much as a year or more.

These problems with Medicaid are not new despite references to “the current climate” in the linked opinion article.
In the current climate, there already exists a logistical nightmare for state education agencies to get proper Medicaid reimbursements. The AASA mentioned the “enormous paperwork hurdles” upfront in its report, and in my year working at the D.C. mayor’s office, Medicaid reimbursements were one of the most complex and pressing policy issues.
Ask any parent or service provider who has had to deal with Medicaid paperwork. The Medicaid system is dysfunctional as it does not adequately deliver services at current funding levels. It does do a great job of creating headaches for families, people with disabilities, and schools and staff trying to do their jobs well. The fact is that Medicaid is a hot mess. The problems mentioned in this opinion article as potentially stemming from proposed funding reductions are problems right now. They have been problems for decades. Consider the issue of chronically low Medicaid reimbursement rates. It’s a problem that hamstrings families and students now and has for years. The low rates limit the number of providers available to those who utilize Medicaid.

One final thought about the following.
By cutting Medicaid funds for schools, the government will force children with disabilities and their families to access necessary, specialized care outside of the education system. Only families with means will be able to access those same services currently available in the school systems, and those services may likely become more costly and more difficult to access.
Families are already doing this, with means or not. More and more of us are refusing to let our children suffer or fail regardless of what it costs us. School districts, governments, and activists could learn a lot from the commitment of families to the success of their children against all odds.


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