NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A957
SPONSOR: Paulin 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 OR GENERAL IDEA OF BILL:
To permit school-based health centers (SBHC) to remain out of Medicaid
managed care.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill amends Social Services Law § 364-j relating to
managed care programs, to provide that school-based health center (SBHC)
services remain carved out from Medicaid managed care.
Section 2 of the bill establishes an effective date.
JUSTIFICATION:
School-based health centers (SBHCs) provide comprehensive physical,
chronic, mental, and dental health services to over 230,000 underserved
youth in rural, urban, and suburban areas of the State, regardless of
insurance status or ability to pay. SBHCs are a proven model for
increasing access to health and mental health services, reducing 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 alterna-
tive to unnecessary hospitalizations and emergency room visits.
Since 1985, SBHCs have been "carved-out" of the Medicaid managed care
program, being paid under fee-for-service. However, the Department of
Health (DOH) has repeatedly attempted and then delayed ending the carve-
out, with the most recent delay having ended on April 1, 2023. This
means that SBHC services could be transitioned to a managed care model.
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% in cuts to funding since 2008, though
their patient population has grown. This bill ends the years of attempts
and delays by making the carve-out permanent and providing stability to
this vital public health service.
PRIOR LEGISLATIVE HISTORY:
2022:A.9288/S.8447, Veto Memo. 154
2023:A.6029/S.2339, Veto Memo. 58
2024: A.8862/S.7840, Veto Memo. 81
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect on April 1, 2025
STATE OF NEW YORK
________________________________________________________________________
957
2025-2026 Regular Sessions
IN ASSEMBLY(Prefiled)
January 8, 2025
___________
Introduced by M. of A. PAULIN, GONZALEZ-ROJAS, SAYEGH, MAMDANI, SIMONE,
SIMON -- read once and referred to the Committee on Health
AN ACT to amend the social services law, in relation to coverage for
services provided by school-based health centers for medical assist-
ance recipients
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 3 of section 364-j of the social services law
2 is amended by adding a new paragraph (d-4) to read as follows:
3 (d-4) Services provided in school-based health centers shall not be
4 provided to medical assistance recipients through managed care programs
5 established pursuant to this section and shall continue to be provided
6 outside of managed care programs.
7 § 2. This act shall take effect immediately and shall be deemed to
8 have been in full force and effect on and after April 1, 2025; provided,
9 however, that the amendments to section 364-j of the social services law
10 made by this act shall not affect the repeal of such section and shall
11 be deemed repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00465-01-5
