NYSBHA Pushes Back Against State's Plan to Transition SBHCs into Medicaid Managed Care Early 2025

“It is especially urgent and critical for New York to maintain the current funding, structure and stability of [school-based health centers], a primary provider of care for children of color in underserved communities, immigrants, adolescents in need of reproductive health and gender-affirming care, given the significant federal changes to the healthcare system and Medicaid in particular that we anticipate as the country transitions to a new administration.”

Empire Report: The Governor must preserve and protect the State’s school-based health centers By Stephen Marshal| November 19, 2024

More Press Coverage

Politico

Crains

Empire Report

Statement from Senator Rivera

managed care a ‘failed experiment’

Why Support the Permanent Carve-Out of SBHCs from MMC Since 1997, SBHCs have been carved-out of the Medicaid Managed Care (MMC) program, enabling them to receive reimbursement directly from the State on a fee-for-service (FFS) basis. Given the insurmountable costs and unresolved issues associated with carve-in implementation, it is critical that SBHCs be able to continue serving children and adolescents with Medicaid on a FFS basis permanently, as provided for in S.7840, Rivera/A.8862, Paulin. SBHCs were initially scheduled to be transitioned into MMC in 2014. The carve-in date has been extended six times since then, most recently in February 2023, postponing the carve-in date to no sooner than April 1, 2024.
September 20, 2024, the State announced a plan to transition SBHCS into Managed Care on April 1, 2025. Unlike other carve-ins implemented by NYS DOH, this one has no ﬁscal savings associated with it. However, it will cost SBHCs and sponsors a signiﬁcant amount of money to implement, while jeopardizing care. Under the carve-in, the centers and their sponsors will face costly and insurmountable administrative challenges involving credentialing, contracting, billing, claims processing for centers, and great instability from payment delays and denials. A permanent carve-out of SBHCs from MMC will ensure they can continue focusing on what they do best – providing comprehensive and much needed health and mental healthcare services to children and adolescents in high-risk areas all across New York.

Previous Successes for NYSBHA

SBHCs Receive $3M in New State Funds in 2024-2025

Extended (Delayed) SBHC's Carved-Out Medicaid Managed Care

New Funding for dental clinics, a community health worker initiative and base funds were included in the State’s most recent Budget bill
Dental funding included in the $3M is first time SBHC-D clinics have been provided State funding specifically

The final Article VII Health and Mental Hygiene budget bill, provides that services provided in SBHCs shall not be provided to medical assistance recipients through managed care programs until at least April 1, two thousand twenty-four.
While this is a shorter delay than we had hoped for, it provides for another year our advocacy efforts

New York's SBHCs See 10% Medicaid Reimbursement Increase

SBHCs will see a 10% increase to the reimbursement rate, equivalent to $1.4M, retroactive to April 1st of this year, as part of a larger enacted State Medicaid enhancement package. SBHCs await CMS approval for this rate increase as of September 2024

Interested in advocating for New York’s SBHCs? Use our sbhc-legislator match list to see representative by sbhc address or use the Assembly and Senate buttons below.

NYSBHA's Legislative Center

Find your Assembly Member

Follow the button and input your street address and zip code to find your New York State Assembly Representative.

Visit your Assembly member’s page and locate the “Contact Me” button on the left to gather the phone numbers, email address, and contact form for your Assembly Member.

Find your Senator

Follow the button and input your street address and zip code to find your New York State Senator.

Click the button “Message Senator” and follow site instructions to create and account and send your Senator a message.

See Our SBHC/Legislator Match List!

Use the link to the right to see NYSBHA’s current sbhc directory and corresponding legislator list to find the right representative.

For any further questions or concerns regarding advocacy, contact us at: nysbha@gmail.com

Alliance Advocacy Center