School-based Medicaid again at risk in Senate Obamacare repeal effort

Kansas school board members and their allies must once again ask U.S. Senators Pat Roberts and Jerry Moran to defend school-based Medicaid services as a new health care overhaul bill appears to be gaining traction in the U.S. Senate. 

Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have authored the latest Republican attempt to repeal the Affordable Care Act (ACA), also known as Obamacare. As with previous Congressional repeal attempts, the Graham-Cassidy measure contains an annual per-capita cap on Medicaid payments to states. School districts across the United States routinely use Medicaid reimbursements to help pay for school-based services like speech, physical and occupational therapy required by the federal Individuals with Disabilities Education Act (IDEA) and for other medical services provided in school settings such as vision and hearing checks. Kansas schools received $46 million in Medicaid reimbursements in calendar year 2015-16. A district by district breakdown is available at this link; click on “Medicaid Reimbursement Cut Impact on Kansas Schools.”  

In a twist on previous ACA repeal proposals, the Graham-Cassidy legislation would give each state a block grant of fixed federal funding for health care and health insurance from 2020-2026; states would have wide discretion over how to use the money, and would not have to provide any of their own funds. 

In a June 28 letter to Kansas Sens. Pat Roberts and Jerry Moran, then-KASB President Amy Martin said the organization’s primary concern with similar attempts to repeal the ACA, through restructuring the Medicaid entitlement program, appear “to go far beyond repealing and replacing ‘Obamacare’ to directly impact Kansas schools that provide special education services to students under the federal Individuals with Disabilities Education Act (IDEA).” 

Martin said the annual per-capita Medicaid cap “could limit the program’s scope of service, potentially forcing states to ration care for school children and requiring local school districts to finance mandatory services through state or local funding sources. If Congress merely seeks to repeal and replace ‘Obamacare’ that is certainly its prerogative” she said. “We urge you, however, to separate that political goal from the very real impact of legislation that appears to go far beyond reinventing the American health insurance system and instead penalizes Kansas schools and students by de facto cuts to education.”  

Media reports on Monday indicated President Donald Trump was calling state governors to press for their support of the Senate bill and Arizona Governor Doug Ducey endorsed the effort. That puts pressure on Arizona Senator John McCain, who was one of three Senate Republicans to vote against a previous Senate ACA repeal proposal.  

Adding to the urgency is a Sept. 30 parliamentary deadline that will force Senators to get 60 votes to pass a bill after that date, compared to the 50 votes now required (the Republican-controlled Senate can count on Vice President Mike Pence to cast the 51st vote needed to pass a bill). With the Senate on recess this Thursday and Friday, that leaves little time for substantive hearings or debate on the Graham-Cassidy proposal. 

Kansas school leaders should contact:

Senator Pat Roberts’ office: Joshua Yurek (  or Bryan Wells (  phone: 202-224-4474  

Senator Jerry Moran’s office: Kyle Christian ( phone: 202-224-6521


Share this post