The new healthcare bill could worsen the stigma of special education

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If Senate revisions to the healthcare bill aimed at repealing key components of the Affordable Care Act don’t include reversing proposed cuts to Medicaid, some of America’s most vulnerable children will be even further marginalized.

When the House voted 217 to 213 in favor of the bill on May 4, it voted to cut Medicaid funding by $880 billion, or 25 per cent, over 10 years.

A small fraction of that — around $4 billion — is earmarked for schools to help children with special needs. While this amount is just a fraction of the total Medicaid budget, $4 billion represents about a third of the FY17 budget appropriation for special education.

{mosads}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 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.

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.

Attempting to collect any amount of compensation for students with special needs was a difficult undertaking. However, adequate funding is vital if we are to fulfill our obligation to provide access to education for students with exceptionalities. Cuts in funding are likely to have a significant impact on academic and career opportunities and long-term consequences of how schools support students with special education needs, given to the overall scarcity of resources.

Without Medicaid there is a huge gap, one left by a decades-old, unfulfilled Congressional promise to cover 40 percent of special needs education costs. As of January this year, the federal funding level hovered at just 16 percent.

Cuts to the Medicaid reimbursements to states could have an effect on the number of teachers who work in special education. The number of qualified educators trained in special education would likely dwindle, spreading even thinner the resources of those teachers working in general education classrooms.

Further, the disparities between higher-income schools where there are typically more involved parents and guardians, and those without such resources, is likely to become even more pronounced. Once again, the most vulnerable children in the highest-needs schools will feel the bulk of the impact.

These cuts are even more disheartening when we consider the long-term impact that cuts to Medicaid will have on children and youth with special needs, given that we have research demonstrating a marked improvement in high school graduation rates for children with special needs since the implementation of Medicaid. Just 41 percent of students with special needs graduated from high school in 1993 compared with 65 percent in 2012.

These cuts will leave us wondering how many children will receive less of the services they need in order to thrive. Will children have their academic and behavioral needs consciously ignored by administrators as a cost-saving measure because resources are tight and identifying yet another student with a disability will only add to that strain?

A cut to Medicaid is a huge step back, one that will likely cost more in the long run. After all — and most experts will agree — early intervention is crucial for development and long-term success, and by stripping schools of Medicaid funding, the government will be stripping school of resources to help children right from the start, including those with or at risk for disabilities.

Cutting resources from early intervention programs in particular means that many students may go without adequate support and may ultimately go on to become adults needing lifelong services, requiring continuous government assistance that they might otherwise not have needed. Cutting special education funding now is likely to result in much more costly expenditures in social services in the long term.  

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.

The parents and guardians who can afford specialized services will also feel the pinch, as they will have to budget both money and precious time to get to these supports, either removing their children from class or tacking on appointments at the end of the school day, thereby foregoing extracurricular or social activities.

The Save Medicaid in the Schools Coalition advocates for school-based services, saying that “schools (can) deliver health services effectively and efficiently since school is where children spend most of their days.”

Transferring the financial responsibility from the federal budget to individuals does nothing but further burden America’s most vulnerable young learners and increase inequality.

Sarah Irvine Belson is the Executive Director of the Institute for Innovation in Education at American University and an Associate Professor in the School of Education. Her research explores educational opportunity for children with disabilities and teacher education policy.

The views expressed by contributors are their own and are not the views of The Hill.

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