The Governor must preserve and protect the State’s school-based health centers
Since taking office in August 2021, Governor Kathy Hochul has made children and families a major focus of her Administration. From expanding access to healthcare through continuous Medicaid enrollment for children up to age 6, providing funding for anti-poverty, food assistance and childcare initiatives, and investing $1 billion for mental health care to expand access to treatment and supports given the unprecedented mental health crisis we are facing in this State. Governor Hochul has also strengthened laws and provided funding to ensure that New York is a safe haven for reproductive health care and gender affirming care including for adolescents. And most recently, the Governor has taken actions against harmful and addictive social media preying on our youth.
Governor Hochul should be commended for her leadership in these areas and for her focus on improving the lives and health of our children. However, there is one more action that the Governor must take this year to meaningfully support our most vulnerable children in underserved communities throughout New York. The Governor must preserve and protect the State’s more than 250 school-based health centers (SBHCs) which provide essential health, mental health, dental and reproductive healthcare services through a highly patient-centered model built around kids and adolescents, where they spend most of the day- in schools. The Governor must reject the plan to shift this critical safety net provider to Medicaid managed care on April 1, 2025, and instead sign S7840, Rivera/A8862, Paulin into law to permanently allow SBHCs to remain in fee-for-service Medicaid, directly administered by the State. This legislation was passed unanimously by the Senate and Assembly during the 2024 session and a majority of Senate and Assembly Members recently co-signed letters to the Governor urging her approval of this critical legislation.
SBHCs have been providing unparalleled care in New York for several decades and have always been paid through the Medicaid fee-for-service model. SBHCs provide comprehensive health services to over 350,000 at-risk youth in rural and urban areas of the State, regardless of insurance type or status or ability to pay. SBHCs are a proven model for closing the gaps in access to health, dental and mental health services, while reducing the need for far more costly care like emergency department visits and hospitalizations. Moreover, SBHCs reduce ethnic and racial disparities in the communities they serve and improve school attendance and performance. SBHCs are critical to the state’s response to the escalating mental health crisis, shortage of pediatric dental care, and to serve as the safety net for migrant families. Yet this model will be placed in great jeopardy if it is forced to move to Medicaid managed care.
The initial push for SBHCs to shift to managed care was part of the Cuomo Administration’s Medicaid Redesign Team (MRT I) recommendations in 2011 to move all Medicaid populations into some form of care management. The plan for SBHCs 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. Ironically, the state’s health plans are opposed to the move of SBHCs to managed care saying, “the current (SBHC) structure does not lend itself to the care coordination practices that health plans rely on and transitioning from the current fee-for-service system would create massive disruption for providers, schools, children and families, and is the reason we support the legislation to maintain the current process” (Politico 10/7/24).
And look no further than the insurmountable barriers patients face in other sectors including behavioral health and home care which have been moved to managed care. Persistent plan denials, delays and red tape dictate whether patients can receive necessary care and only add 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 increased administrative 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 (another MRT recommendation) raised a number of concerns and red flags, cautioning against a move to managed care. The same caution and rejection should be taken for SBHCs.
It is undeniable that the State has a serious access crisis for pediatric dental services in our low income communities, both rural and urban. A new study from SUNY Albany’s Center for Healthcare Workforce Studies found that one in six New Yorkers who needed dental care in the last year could not get it and some patients are forced to wait years before accessing a dentist. Access rates are even lower for Black New Yorkers and those of lower income with Medicaid. The study suggests New York can improve its rates by better integrating oral care with medical care, which is exactly what SBHCs do for children, primarily children of color with Medicaid. This is exactly why New York should be supporting and growing the SBHC model not pursuing destructive insurance reforms that will dismantle it.
As a dentist in New York, I have seen the impact of this serious disparity firsthand. Limited access to dental care can have a lifelong effect on children’s oral and overall health. The cause is multi-faceted but SBHCs are playing a major role in filling these gaps for children who would otherwise have no access to essential, dental care. Over 100,000 dental care visits were provided by SBHCs in NYC this year alone. However, much of this care is provided through mobile services and these dental providers will never be designated by managed care plans as the primary provider for these youth. And health plans greatly underpay for the costs of dental care and services. Managed care simply won’t work for SBHC dental care and must be reconsidered due to the detrimental effect it will have on child access to dental and all needed services that SBHCs provide.
As the country prepares for the transition to a new President and Congress, it is especially urgent and critical for New York to maintain the current funding, structure and stability of SBHCs, a proven safety net for children of color in underserved communities, immigrants, and adolescents in need of reproductive health and gender affirming care, given the significant federal changes to the healthcare system and Medicaid in particular that are anticipated. 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. Governor Hochul, consistent with your strong focus on children and families in New York, please reject the shift to manage care and instead, sign S7840, Rivera/A8862, Paulin into law to protect and bring stability to this irreplaceable, child-centered public health service.
Stephen Marshall, DDS, MPH is Chair of the New York School-Based Health Alliance.
