Health bill may hurt Medicaid recipients Special education families, school leaders concerned about future of Medicaid reimbursements

Amy Trail's son Noah has severe autism and epilepsy. Every week, he gets behavioral, speech, occupational and physical therapy. More help comes from home aides who work for the family.

Most of the services the 12-year-old receives at school and home, and the medications he takes daily, are paid for by Medicaid. Trail tallied it up once and estimates Noah's services run about half a million each year.

To Trail, though, the help is priceless. It improves his quality of life and her family's.

"These services keep him alive," she said.

Trail and other parents of special-needs children are anxious over the prospect of losing services under the proposed Senate Republican health care bill. School districts, which provide many of the services their children receive and get reimbursed through Medicaid, are worried, too.

"We're all pretty concerned," said Trail, who helps other parents of special-needs children navigate schools as an advocate. "It's not even just going to impact our households. Our entire community as a whole is going to get hit pretty hard if this goes through."

Between 2016 and 2026, the Senate bill cuts Medicaid spending by 26 percent, according to an analysis from the nonpartisan Congressional Budget Office. About 69 million Americans receive Medicaid; the bill is estimated to cut enrollment by 16 percent by 2026.

Democratic Sens. Tim Kaine and Mark Warner both oppose the legislation, which was scheduled for a vote last week that ended up being postponed until after the Senate'sJuly 4 recess.

The bill would have a disproportionate effect on children, who make up about 60 percent of Medicaid enrollment in Virginia, Kaine said in a conference call with reporters last week.

During the 2014-15 school year, the most recent year for which data is available, Virginia school districts received $33 million in Medicaid reimbursements, according to data compiled by his office. A little more than $1.6 million of that went to school districts in the Roanoke and New River valleys.

"When you take that much out of Medicaid, you hurt the most vulnerable people," Kaine said.

About 1,000 Roanoke students received Medicaid services through the school system last year, about 7 percent of the district's enrollment.

The types of Medicaid services that Roanoke students receive are similar to the ones Noah Trail gets in Franklin County. In Roanoke, the district also helps families with students receiving Medicaid navigate the health care system, helping them schedule and attend doctor appointments.

Last year, Roanoke was reimbursed by Medicaid by more than $400,000.

"Do I recognize that this stuff is expensive? Of course," Superintendent Rita Bishop said. "But these are kids. The kids here have some really important things that we need to attend to, and we'll do our doggondest to. ... Unless you have no passion, you want to do something about it, don't you?"

Under the federal law for children with disabilities, Roanoke and other school districts have to provide appropriate services like behavioral, occupational, physical and speech therapy to children who have a documented educational need.

Districts will still have to provide those types of services to students if the Senate bill becomes law. The concern parents and districts have is that if Medicaid funding decreases overall, reimbursements will be cut and costs will be shifted to school districts. They'd have to find the money somewhere else.

In recent years, both the costs and the need for those types of services have grown. In the Roanoke and New River valleys, the number of students receiving special education services, many of which are covered by Medicaid, grew by about 5 percent in the past five years.

School districts already struggle with the costs of special education, which have never been fully funded by the federal government, Bishop said. This would add another layer of costs, she said.

Trail said many parents of students in special education feel it's already a struggle to get the services their children need. Parents worry that if districts can't count on Medicaid, districts will push back and argue the services aren't needed, she said.

"They're going to have to find a way to save money," Trail said, hypothesizing that schools might try to cut services like an hour of speech therapy down to just half an hour.

Jessica McClung, Roanoke County's director of special education, said she doesn't think Medicaid cuts would play out like that in that district. Roanoke County's reimbursements are smaller than the city's, from around $130,000 to $350,000 over the past few years.

That money is a small supplement to the "pathetic" amount the federal government provides for special education, she said. In the c

ounty, Medicaid reimbursements pay for things like equipment or classroom materials, like labs that let students practice household and work skills.

Districts will do what they need to do to meet their requirements under the federal law for children with disabilities, but they just won't have as much flexibility without the reimbursements, McClung said.

"Our kids have a lot of need and any way we can help them, we want to," she said. "But losing that funding of course is going to have a detrimental effect."

Young adults with disabilities who have aged out of school but still receive Medicaid services would also be hurt by cuts, said Angie Leonard, who founded the Blue Ridge Autism and Achievement Center. Leonard said she's seen the effect of Medicaid funding directly through the services her son Joshua receives.

Medicaid has paid for therapies and interventions that have enabled the 22-year-old to live more independently, she said. He has a job now, something that was only possible with help from a job coach paid for by Medicaid.

Joshua Leonard came with his mother last month when she traveled to D.C. to meet with Warner and other families with special-needs children and share her opposition to the Senate bill.

"I was able to say, look, this is what good services look like," Angie Leonard said. "This is what happens, look at the outcomes. They become really strong members of our society."

Trail and others concerned by the bill breathed a little easier after the Senate vote was postponed but say they'll continue to lobby against the cuts.

"These children are dependent on all of us finding a way to combat this," Trail said.