Introduction to the Issue
Florida lawmakers reached a rare consensus after the deadly Parkland school shooting: More money was needed for mental health counseling at schools. “We haven’t put enough resources into mental health issues,” said then-Sen. Kathleen Passidomo, R-Naples. “And look what happens.” Two years later, lawmakers passed a bill allowing Medicaid dollars assigned to school districts to be used for more types of care for kids, including counseling. But state officials didn’t adopt the changes. And they have refused to comply with federal guidelines that would help school districts provide that care.
The Scale of the Problem
Florida schools have missed out on about $200 million a year in Medicaid funding — a total of $2.2 billion since 2014 — to support children’s mental health counseling, physical therapy and other services, advocates say. Their calls to recoup funding come as schools face multimillion-dollar shortfalls in the budget year that began July 1 — and as kids struggle with the fallout from the COVID-19 pandemic. They say the problems lie with the Florida Agency for Health Care Administration, which oversees Medicaid in the state and reports to Gov. Ron DeSantis. Documents show that for more than a decade, the agency hasn’t followed federal reimbursement guidelines for school-based services — one of the few areas of Medicaid the Trump administration and Congress have not targeted for reductions.
Federal Guidelines and State Non-Compliance
The federal program provides in-school medical care and instruction for school-age children with physical or developmental disabilities who qualify for Medicaid. About 2 million children in Florida are on Medicaid, which provides free or low-cost health care to people who qualify. Without the money, school districts have struggled to find therapists, nurses and others to treat children. Some kids experienced lower-quality care or had that care delayed during critical periods of their lives, observers say. The state agency strayed from federal guidelines in 2014, when the U.S. government changed its rules regarding the reimbursements. Experts consulted by the Times said Florida is one of the few states, and perhaps the only one, that is using the outdated payment method.
Impact on School Districts
The federal Center for Medicaid and Children’s Health Insurance Program Services warned the agency in 2020 that it was “not in compliance with current financing rules,” but no substantial action followed. Over that time, instead of collecting $2.2 billion from federal coffers to cover school-based expenses, the state received about $250 million. With money tight, school officials want the agency to make the necessary fixes. “This is a significant agency failure,” said Ken Kniepmann, former state assistant deputy secretary for Medicaid Policy and Quality at the agency. He was hired in part to improve the system but said he was later instructed to stop. “It’s really unconscionable. Nobody should be OK with this.” A spokesperson for the agency said it did not have sufficient funding to update its reimbursement method until this year’s legislative session, and it is committed to getting it done next year.
Attempts to Address the Issue
Kniepmann said the agency had not asked the Legislature for permission to draw down the federal dollars needed to enact the changes until this year. The Hillsborough County school board held a workshop in April to address the Medicaid funding gap. Hillsborough received about $6 million in Medicaid reimbursements a year ago for the services it provided, specialist Deneen Gorassini told her board, but would have gotten about $10 million more if the state agency followed federal guidelines. It’s money that could have expanded medical and mental health services in schools. Other districts experienced similar-sized gaps, according to Kniepmann’s calculations.
Potential Solutions and Challenges
“If we can get (the agency) to do their job and submit a (state plan amendment), we could start getting reimbursed based on our expenses, which are way more than what we are getting reimbursed now,” Gorassini told the board. Since 1997, the state has been reimbursing school districts for services — such as counseling or speech therapy — based on a flat rate. In 2014, the federal government required states to reimburse school districts based on the actual costs of those services, which is much higher. Five years ago, federal officials wrote Florida telling them it hadn’t adopted the change, and the state had 90 days to comply. “Please note that you may not pay a rate from a fee schedule and use this as a certification of cost,” Center for Medicaid and CHIP Services acting director Todd McMillion wrote Florida officials in March 2020.
Long-Term Effects and Concerns
Florida is still paying schools a flat rate that has changed little since 1997. Karen Thomas, a Medicaid specialist for Leon County schools for more than 20 years, said that while the formulas are complex, the solution should be “extremely simple.” “We’re 90% there, maybe 95% already, in the way we are doing things,” Thomas said of districts’ processes for collecting receipts and monitoring providers’ time. “They have everything they need to be in compliance with federal payment methodology. They just need to change the invoice, one line on the invoice. … The fault is squarely in the agency’s failure to come into compliance.” The state has shown it can make the switch, Thomas said. She pointed out that when federal authorities ordered county health departments to start billing for actual costs instead of flat rates in 2020, the state quickly shifted.
Conclusion
The issue of Medicaid funding for schools in Florida is complex and multifaceted, with significant implications for the health and well-being of the state’s children. The failure of the Florida Agency for Health Care Administration to comply with federal guidelines has resulted in a loss of $2.2 billion in potential funding, which could have been used to expand medical and mental health services in schools. As the state moves forward, it is essential that officials prioritize the needs of its most vulnerable citizens and work to address the systemic issues that have led to this crisis.
FAQs
Q: How much Medicaid funding have Florida schools missed out on since 2014?
A: Florida schools have missed out on about $200 million a year in Medicaid funding — a total of $2.2 billion since 2014.
Q: What is the main reason for the missed funding?
A: The main reason is the Florida Agency for Health Care Administration’s failure to comply with federal reimbursement guidelines for school-based services.
Q: How many children in Florida are on Medicaid?
A: About 2 million children in Florida are on Medicaid, which provides free or low-cost health care to people who qualify.
Q: What services are affected by the funding gap?
A: The funding gap affects medical and mental health services in schools, including counseling, physical therapy, and other services.
Q: What is being done to address the issue?
A: School officials and advocates are working to raise awareness about the issue and push for changes to the state’s reimbursement method to bring it into compliance with federal guidelines.
