New York State Must Prioritize Access to School-Based Health Centers (SBHCs) for its Most Vulnerable Youth & Say No to Managed Care

Coalition Asks Governor Hochul to Reject 4/1/25 Shift to Managed Care to Protect Current Medicaid Model for SBHCs

On Friday, September 20, 2024, the State Department of Health made a very troubling announcement to school-based health centers and their sponsoring organizations of the State’s intent to move the SBHC benefit under Medicaid to managed care on April 1st, 2025. Such action would have a devastating impact on this highly effective model of care for New York’s underserved youth. Today, a broad coalition of state legislators, health and education providers are calling on Governor Hochul to reject this shift and instead sign S7840, Rivera/A8862, Paulin into law to permanently allow school-based health centers to remain in Fee-for-Service Medicaid, directly administered by the State.

This legislation passed unanimously in the Senate and Assembly in recognition of the immense value of the school-based health center (SBHC) model in meeting the health care needs of kids in the most underserved areas of the State. This includes physical health, mental health, dental, reproductive health and other services that children are able to access where they are most of the day- in schools.

School-based health centers provide comprehensive health services to over 350,000 at-risk youth in rural and urban areas of the State, regardless of insurance status or ability to pay. SBHCs provide over 100,000 dental visits per year for children who would otherwise have no other dental access. SBHCs are a proven model for increasing access to health, dental and mental health services, reducing ethnic and racial disparities in the communities they serve, and improving school attendance and performance. SBHCs are needed now more than ever with the state’s escalating mental health crisis, shortage of pediatric dental care and to serve as the safety net for migrant families. Yet SBHCs and these services will be placed in jeopardy if the State moves forward with its planned shift to managed care effective April 1, 2025.

SBHCs have always been “carved-out” of Medicaid managed care (MMC) in New York State. SBHCs were initially scheduled to be transitioned into MMC in 2014. The carve-in date has been extended seven times since then, most recently in April 2024, postponing it to no sooner than April 1, 2025. Over the last decade, no solutions have been identified to address the intractable issues that managed care would pose on SBHCs. This includes significant administrative and financial burdens which threaten the continued viability of this critical safety net provider for

New York’s youth. The plan to move to managed care does not have any savings attached to it and yet it will increase costs for the state which will have to pay managed care plans to administer the coverage, while also paying for many protections to try to make this unworkable model for SBHCs fit.

Look no further than the insurmountable barriers to accessing health care for other sectors including behavioral health and home care in managed care. Persistent plan denials, delays and red tape dictate whether patients can receive necessary care and only adds costs to the system –in the timeliness of care impacting outcomes, in reimbursement delays and in paying “middlemen” to administer coverage for services. SBHCs and their sponsoring organizations which are hospitals and health clinics can ill afford the transition’s costs, nor the ongoing delays and denials that have decimated providers in other sectors. A recent study looking at the possibility of managed care for New Yorkers with developmental disabilities also raised a number of concerns and red flags.

Our children who are already facing many other challenges deserve to know their SBHC will always be there for their health, dental and mental health needs. Together, we urge Governor Hochul to reject the shift to manage care and instead, sign this critical bill into law to protect and bring stability to SBHCs and the children who depend on their essential services. We asked Governor Hochul to say no to managed care for SBHCs. This legislation ends the years of uncertainty and enables SBHCs and their partners to direct all resources toward ensuring the viability and growth of this vital, child-centered public health service.

“”I am deeply concerned about the Executive’s decision to transition the School-Based Health Center (SBHC) program to Medicaid Managed Care (MMC) despite my bill awaiting her signature following unanimous support to keep the program in Medicaid Fee-For-Service (FFS) permanently. We can address issues with the program without dismantling the current funding structure that effectively supports it. SBHCs are an effective model for expanding access to medical, dental, and mental health care to every child in our state. I am urging the Hochul administration to come to the table to find a path forward that doesn’t jeopardize access to healthcare at schools for New York’s most vulnerable children,” said Senate Health Committee Chair Gustavo Rivera.

““School-based healthcare is an effective way to achieve health equity among children,” said Assembly Health Committee Chair Amy Paulin. “If we place critically needed services like medical, behavioral, dental, and vision care directly in schools, more young people, regardless of their means, will have access to these essential services. For years, SBHCs have provided care to children with great success under a Fee-For-Service model. The recent announcement from the Office of Health Insurance Programs to carve SBHCs into Medicaid Managed Care is extremely troubling as SBHCs don’t have the resources or administrative support to be in Medicaid Managed Care. I urge Governor Hochul to sign A.8862/S.7840 into law so that SBHCs can continue to provide critical care to New York’s most vulnerable youth.”

“While we have heard in the past that MMC is needed to ensure care coordination and the potential for value-based payment (VBP) arrangements, we strongly disagree,” said Sarah Murphy, Executive Director for the New York School-Based Health Alliance. “There is strong care coordination today with the existing model and we are glad to work with the state and other stakeholders to further enhance it. VBP arrangements can be made with plans through SBHC sponsoring organizations, and are certainly not a reason to dismantle the current system, threatening the viability and future of SBHCs and the critical services they provide. Governor Hochul, please stand up for New York children and sign this bill into law.”

“New York must protect and continue to invest in this highly effective model of care that is built around the specific needs of children and teens in the state’s most underserved communities. School-Based Health Centers keep kids healthy and prevent far more costly emergency department and hospital visits, and managed care would dismantle this vital safety net. We urge Governor Hochul to sign these critical protections for our most vulnerable young people into law, “said 1199SEIU Interim Political Director Helen Schaub.

“Greater New York Hospital Association (GNYHA) strongly supports this important bill,” said GNYHA Vice President of Government Affairs Andrew Title. “Our member hospitals sponsor school-based health centers that provide primary, mental, and dental health care for over 100,000 children in the Bronx, Brooklyn, Queens, Manhattan, Staten Island, Buffalo, Yonkers, and Rochester. Mandatory managed care participation would impose a costly administrative burden on these critical safety net clinics, with no benefit for the at-risk children they serve. We urge Governor Hochul to sign S7840/A8862 into law.”

“For years, the state has recognized the importance of keeping school-based health centers out of Medicaid managed care. The impending transition’s significant administrative and fiscal impacts will threaten vulnerable children and adolescents’ access to essential healthcare services, said Amy Nickson, senior vice president, state policy, Healthcare Association of New York State. “We urge Gov. Hochul to sign S.7840/A.8862, permanently keeping SBHCs out of Medicaid managed care so these providers can continue to focus their resources where needed most – caring for New York’s kids.”

“The Medicaid carve out is the lifeline for School Based Healthcare Centers across NYS. It allows School Based Healthcare Centers to provide safety net healthcare to the poorest children in the state, so the children they serve can receive care, remain in school and learn. It is crucial that Governor Hochul signs this bill and prevent the managed care carve in,” said Kim Utech, 1199SEIU Delegate & Nurse Practitioner at Oishei Children’s Hospital in Buffalo.

The organizations listed below strongly support the permanent carve-out of School-Based Health Centers (SBHCs) from Medicaid Managed Care (MMC) and urge Governor Hochul to sign S7840/A8862 into law.

New York School-Based Health Alliance
1199SEIU United Healthcare Workers East
Bassett Healthcare Network
Children’s Aid
Citizens’ Committee for Children of New York
ConnextCare
Greater New York Hospital Association
Healthcare Association of NYS (HANYS)
Institute for Family Health
Kaleida Health
Montefiore
North Country Family Health Centers
New York School-Based Health Foundation
Northwell Health
NYS Community Schools Network
NYS Network for Youth Success
NYU Langone Family Health Centers
Open Door Family Medical Centers
Smile NY Outreach
University of Rochester
Urban Health Plan