Spec.-Ed. Advocates Wary of Health Plan's Impact
The Clinton Administration's proposed "health security act'' could result in reduced health-care coverage for students with disabilities, some advocates for the disabled fear.
The plan may also alter the financing of medically related services for special-education students.
Reaction from the disability-rights and special-education communities has been muted, largely because advocates are unsure about the potential impact of the Clinton plan, which contains little specific language on coverage for disabled people. Some specific concerns have emerged, however.
"There is a piece missing in the plan,'' said Vivian Gabor, a lobbyist for the March of Dimes.
Her organization and others are concerned that children with congenital and developmental disabilities would not be eligible for outpatient rehabilitation and other services, because their conditions are not caused by "illness or injury.''
"The basic-benefits package should cover those services whether they're covered now or not,'' Ms. Gabor argued.
Ever since the earliest drafts of the plan were leaked to the news media, a pressing question for special educators has been whether the plan would undermine Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Services program.
Introduced in 1986 and strengthened in 1989 to include a broader range of services and providers, including schools, the E.P.S.D.T. program mandates that Medicaid-eligible children receive the treatment their doctors believe they need.
The program also lifted part of the burden of financing medically related services for special-education students from the schools, by making it possible to obtain some Medicaid funding from states.
The 1989 revisions also made school-based health-care providers eligible for Medicaid reimbursement, making it easier--at least in theory--for states to bill Medicaid for these services.
One study estimated that E.P.S.D.T. was worth $30 million to school districts in Massachusetts alone, and some observers call this figure conservative.
Falling Between the Cracks?
The draft of the plan that was leaked in September lacked even a nod to E.P.S.D.T.
Kathleen McGinley, assistant director of The Arc, an advocacy group for retarded citizens, said then that students with disabilities who receive Medicaid benefits are currently getting "a richer package than in the Clinton plan.''
"We were concerned that congenital problems and developmental delays wouldn't be covered,'' Mark Kander of the American Speech-Language-Hearing Association, said at the time.
And advocates are uncertain about whether these questions were answered in the final, 1,400-page version of the President's proposed "health security act.''
The package states that families receiving welfare payments or cash assistance under the Supplemental Security Income program would continue to receive services for which they are currently eligible.
But advocates fear that some seven million children who do not receive cash assistance but have family incomes low enough to qualify them for E.P.S.D.T. would be absorbed into the general pool of insured Americans under the Clinton plan, with the assumption that they would be receiving all necessary services from the basic package of benefits.
"The big concern is what's going to happen to those kids who are not on [Aid to Families With Dependent Children] or S.S.I., and not below poverty levels, but who are medically needy,'' said Kelly Henderson of the Council for Exceptional Children.
Low-income families would be eligible for subsidies to supplement their health-care expenses under the Clinton plan. But the basic-benefits package does not cover all the services that advocates say disabled children need.
Provisions in Question
It also does not cover some of the medical services that form part of some students' individualized education plans, and advocacy groups are uncertain about the plan's potential effect on special-education finance.
The Individuals With Disabilities Education Act requires districts to provide medical services needed to enable children with disabilities to receive an education.
The bill that the Administration delivered to Congress contains the "program for poverty-level children with special needs,'' which seems to some observers to be a substitute for E.P.S.D.T.
"This appears to be an attempt to address it,'' said an aide to the Senate Subcommittee for Disability Policy. "The issue is going to be if it thoroughly addresses it.''
Spending on the program would be capped at fiscal 1993 levels, which could prove seriously inadequate if states and schools that do not now do so attempted to draw on Medicaid funds for children with disabilities.
"I don't want to leave the impression that everything's O.K.,'' said the legislative aide, who said his subcommittee would investigate the issue.
The current processes through which special-education administrators can obtain insurance or Medicaid funds are intricate and often yield a meager payoff.
Footing the Bill
In some instances, districts have asked parents to use their own health-care plans to cover their children's expenses. If parents agree, however, this can have disastrous consequences for some special-education students, who are sometimes left with no insurance at all after lifetime-payment caps are reached. Legislation has been aimed at protecting parents from these risks. (See Education Week, Jan. 24, 1990.)
Some districts and states have had better luck in obtaining state Medicaid funds for services such as counseling and occupational and speech therapies.
Districts have made arrangements by which they bill Medicaid for each service they provide. But the paperwork can consume up to 15 percent of the money recovered.
"That's a big chunk,'' observed Frosyne Mensendick, the special-education administrator for the Seattle school district.
Districts can also make arrangements with Medicaid officials for "capitated'' billing, under which schools receive a specific amount in advance for each eligible student, but this option has yet to gain wide usage.
In at least four states, some districts have negotiated a closer partnership with Medicaid, in which school employees shoulder some of the program's administrative burden and draw part of their salaries from Medicaid.
Observers say it is too early to gauge how districts may have to change their ways.
"There are a lot of people who are worried about whether they should stop working on Medicaid refinancing,'' said a Washington-based analyst who studies Medicaid-financing issues. "My sense is that this is not a stop-everything kind of bill.''
A Boon for Schools?
The most optimistic observers note that the Administration has made a commitment to guaranteeing universal health-care coverage, and argue that this will insure that children with disabilities get the coverage they need.
Bruce Hunter, a senior associate executive director for government relations for the American Association of School Administrators, believes that universal coverage will produce savings for districts, as services such as occupational and physical therapy will be covered under the basic-benefits package. "I see so many good possibilities in [the Clinton plan],'' he said.
Several special-education and disability-rights lobbyists noted that the plan must work its way through a long deliberative process.
"If we don't get it now, we'll see what we get in Congress,'' one