BILL NUMBER: S8902
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the social services law, in relation to coverage for
services provided by school-based health centers for medical assistance
recipients
 
PURPOSE:
To permit school-based health centers (SBHC) to remain out of Medicaid
managed care.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill amends section 364-j of the Social Services law,
relating to managed care programs, to provide that SBHC services remain
permanently carved out from Medicaid managed care.
Section 2 of the bill establishes an effective date.
 
JUSTIFICATION:
SBHCs provide comprehensive physical, chronic, and mental health
services to over 250,000 underserved youth in rural, urban, and suburban
areas of the State and an additional 100,000 kids receive essential
dental services through SBHCs. Children receive healthcare services
regardless of insurance status or ability to pay. SBHCs are a proven
model for increasing access to health and mental health services, reduc-
ing ethnic and racial disparities in the communities they serve, and
improving school attendance and performance. They have a proven track
record of reducing healthcare costs by offering preventative care and an
alternative to unnecessary hospitalizations and emergency room visits.
Since 1985, SBHCs have been "carved-out" of the Medicaid managed care
program and are instead paid under fee-for-service. Recently, the
Department of Health (DOH) announced the State's intent to move SBHCs
under Medicaid to managed care on April 1st, 2025, which was later
delayed in the State budget to April 1st, 2026.
If carved in, SBHCs will be required to negotiate the terms and condi-
tions of payment through managed care plans, with prior authorization
and utilization review, delaying care for New York children who rely on
these centers and adding to their administrative burdens. Already, SBHCs
have suffered from nearly 30% cuts to funding since 2008, though their
patient population has grown. The number of total SBHCs has been steadi-
ly declining and further cuts and administrative costs are likely to
result in additional closures and reduced access to care for children.
This bill would end the years of attempts and delays to transition to a
managed care model by making the carve-out permanent, and would provide
stability to this vital public health service.
 
PRIOR LEGISLATIVE HISTORY:
2021-2022: S8447 Rivera/A9288 Gottfried - Vetoed memo 154
2022-2023: S2339 Rivera/A6029 Paulin - Vetoed memo 58
2023-2024: S7840 Rivera/A8862 Paulin Vetoed memo 81
2024-2025: S1224 Rivera/A957 Paulin- Vetoed memo 45
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that the
amendments to section 364-j of the social services law made by this act
shall not affect the repeal of such section and shall be deemed repealed
therewith.

Statutes affected:
S8902: 364-j social services law, 364-j(3) social services law