Relates to coverage for services provided by school-based health centers for medical assistance recipients

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

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.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.