Alliance Executive Director Sarah Murphy attended the NYS Assembly Standing Committee on Health’s Public Hearing: Medicaid Program Efficacy and Sustainability November 1st to provide testimony in response to the topic: Whether some Medicaid services or populations should be carved out of Medicaid managed care, and if so, which ones would benefit?
Additional topics included the Medicaid Managed Care global cap and the 340B pharmacy carve out. Full agenda and list of speakers can be found on the Assembly’s website. Testimony was by invitation only; see NYSBHA’S testimony below.
ASSEMBLY STANDING COMMITTEE ON HEALTH
MEDICAID PROGRAM EFFICACY AND SUSTAINABILITY
NEW YORK CITY
250 BROADWAY, 19TH FLOOR HEARING ROOM
NOVEMBER 1, 2021, 10:00AM
Thank you for the opportunity to testify at this hearing. My name is Sarah Murphy. I am the Executive Director of the New York School Based Health Alliance. The Alliance is a membership organization representing the State’s 266 School-Based Health Centers (SBHCs) who provide services to over 260,000 medically underserved children in the State.
On behalf of the Alliance I would like to thank Assembly Health Committee Chair Richard Gottfried and this entire panel for the generous and sustained support that you have provided to School-Based Health Centers and the children and adolescents that we serve.
SBHCs provide primary, preventive, dental, mental, and reproductive health care services, as well as chronic and other types of care to underserved populations on-site in schools. They are required to provide access to care to every child who enters their door regardless of insurance status- a feature that is central to the success of the program and makes SBHCs a critical part of the safety net.
SBHCs are a powerful tool for reducing racial and ethnic disparities. According to the State Department of Health, 44% served are Hispanic or Latino and 27% are Black or African American. They are safety-net providers for children who are undocumented and/or uninsured and are a critical point of care for immigrant children. Currently 12% of patients served statewide by SBHCs are uninsured.
Many of the young people that we serve live in communities with a high incidence of drug and alcohol abuse, violence, teen pregnancy, and sexually transmitted diseases. Seventeen percent live in rural areas where geography and shortages of health and mental health providers make access to services extremely difficult. For some youth SBHCs are their only source for counseling, health screenings, reproductive care and immunizations.
Repeated studies have shown that SBHCs improve the health and mental health of children and save the State money. SBHCs prevent unnecessary hospitalizations, reduce emergency room visits, improve school attendance and avoid lost workdays for parents. For example, one study shows that SBHCs reduce ER use and hospitalizations by half for asthmatic students.
My primary focus at this hearing today is to address the subject of Question Number Two: “Whether some Medicaid services of populations should be carved out of Medicaid, and if so, which ones would benefit?
School-Based Health Centers have been carved out of the Medicaid Managed Care program since 1985. The Alliance strongly advocates that SBHC sponsors be given the choice of whether to remain in the Medicaid Fee for Service program or to participate in Medicaid Managed Care.
We believe that this choice should be provided to SBHCs and that it will advance the mutual goals of the New York State Department of Health and the Alliance of improving quality and coordination of care.
The Alliance has participated in Work Group meetings with the Department of Health, representatives of hospitals, Medicaid Managed Care Plans, community health centers, and other stakeholders over the past 9 years. It became clear during these meetings that the unique features of the SBHC model make it a difficult fit for Medicaid Managed Care and that integration poses significant administrative burdens for SBHCs, most of which have limited finances and staff. Unlike most other carve-ins, the State is not taking any savings for the SBHCs. However, implementation will greatly increase the costs to centers, most of whom have limited financial resources.
For example, the requirement of serving all students, a feature that is central to the success of the program, necessitates SBHC sponsor participation in all health plan networks as well as vendor networks that provide dental and mental health care. This applies whether the student is in a health plan, in or out of a network, or is uninsured. Sponsors will be required to spend enormous time and expense negotiating numerous contracts for a relatively small service within their system.
Claims and billing systems for both SBHC sponsors and plans will require time consuming and expensive system reconfigurations. For SBHCs, their sponsor’s IT team must develop, test and implement customized billing mechanisms using rate codes specific to go to plans in and out of network.
Legislation passed this year by the Senate and Assembly, S2127 (Rivera) /A1587 (Gottfried), would alleviate these administrative and financial burdens while at the same time advance our mutual goals. The bill provides that the Department of Health would periodically share data directly with the plans and SBHCs. The Department would develop a standard MOU to be entered into by sponsors and health plans outlining the framework for SBHC participation in plan networks, including responsibilities for coordination with primary care providers and participation in quality improvement initiatives. This process should not be an administrative burden on NYS DOH since they currently share Quality Assurance and Reporting Requirement (QUARR) data on a regular basis with Medicaid Managed Care plans.
Finally, it is important to note that Department of Health data shared with the Work Group shows that there is no duplication of services between SBHCs and primary care physicians in the community, there is underutilization of well-child visits in the Medicaid program, and that there is a 25% increase in the number of children who had a well child visit when the child had access to both a Medicaid Managed care plan and a SBHC. This underscores the value of School-Based Health Centers as a cost-effective, critical access point of care for medically underserved children and adolescents in the State.
Thank you for the opportunity to testify at this hearing.