S.7840/A.8862 – Medicaid SBHC

Re: S.7840 (Rivera) / A.8862 (Paulin) — AN ACT to amend the social services law, in relation to coverage for services provided by school-based health centers for medical assistance recipients

HPA supports S.7840/A.8862, which would allow school based health center (SBHC) services to remain outside the Medicaid Managed Care (MMC) benefit package.  Discussions between the Department of Health (DOH), SBHC providers, SBHC sponsors and health plans have been occurring over the past several years and substantial operational issues remain, including the transition period from fee-for-service (FFS), and credentialing, billing and claims processing concerns.  Furthermore, the unique relationship between SBHC providers and their sponsors create significant administrative burdens in the contracting process with MMC plans.

To achieve a carve-in accordance with the previous DOH guidance document, health plans, SBHC providers and SBHC sponsors are required to do a significant amount of work to comply with the implementation plan with no change in the benefit to the recipient, at a time when SBHCs are already struggling operationally.  All parties are likely to incur considerable administrative costs at a time when the state and plans need to focus on the massive Medicaid eligibility recertification effort that began at the end of March 2023.

For these reasons, HPA supports continuing to allow SBHC services to remain outside of the MMC benefit package.