Issue Analysis

Since January 2017, efforts to repeal and replace the Affordable Care Act (frequently referred to as Obamacare) have been underway in earnest by the Republican-majority U.S. Congress. These efforts culminated in a shocking defeat for the GOP in the U.S. Senate when they failed to pass their own ACA repeal bill on July 28, 2017 and again in late September 2017.

All proposed bills in both the U.S. Senate and U.S. House had included fundamental changes to Medicaid, including a roll-back of the Medicaid expansion and shift to per-capita funding for states. These changes would have cut more than $880 billion from Medicaid, which experts projected will lead to tens of millions of people losing health coverage and force states to ration services and reduce access to care.

We will continue to monitor and report on any future developments that impact the ACA and school Medicaid programs.

Impact on School Medicaid Programs

Currently, school-based Medicaid programs provide federal reimbursement in the form of a federal match which is based on how much states have already spent providing eligible care to Medicaid students.

School-based direct billing and administrative claiming programs faced serious threat under both the U.S. Senate and U.S. House repeal and replace bills, which would have eliminated the federal match and replaced it with a fixed amount to cover health care costs for each beneficiary. The likely result would have subjected millions of disabled and low-income children to reductions in health coverage and a loss of vital school-based health services and programs.

Children who rely on school health services to meet various health and behavioral needs, including students receiving Special Education services under the Individuals with Disabilities Education Act (IDEA), would have been on the front lines of those negatively impacted under the federal health bills if school-based Medicaid programs ceased to provide federal matching funds for school health services.


  • September 26, 2017 – Graham-Cassidy fails to garner enough votes to pass the U.S. Senate and GOP admit defeat on the bill without bringing it to the floor for an official vote.
  • September 13, 2017 – GOP Senators Lindsey Graham and Bill Cassidy announce new legislation to repeal the ACA, known as Graham-Cassidy.
  • July 28, 2017 – Federal health reform is effectively defeated in the U.S. Senate after both the repeal and replace (BHRA) and so-called 'skinny repeal' bills failed to garner the necessary votes to proceed.
  • June 23, 3017analysis of a 'carve-out' for children receiving Social Security Income (SSI) in the Senate bill begins rolling out, revealing this to be an ineffective solution to the loss of coverage and access to affordable care that would befall more than six million children with disabilities in the U.S.
  • June 22, 2017 – the U.S. Senate releases their version of the AHCA health bill, called the Better Care Reconciliation Act. Details are strikingly similar to the House bill, including a roll-back of the Medicaid expansion and a shift to per-capita funding (both which threaten school-based Medicaid programs).
  • May 4, 2017 – the U.S. House of Representatives passes an amended version of the AHCA, 217-213. This version includes amendments that would allow states to opt of out requiring insurers to provide essential health benefits (EHBs) to their beneficiaries and also allow states to permit insurers to deny affordable coverage to people with pre-existing conditions. See this timeline by Health Affairs for full details.
  • May 2, 2017 – the Save Medicaid in Schools Coalition sends a letter, signed by several stakeholder and advocacy groups, to House leadership urging them to vote no on the AHCA.
  • April 28-May 4, 2017 – the Save Medicaid in Schools Coalition organizes national advocacy efforts aimed at thwarting passage of the AHCA and protecting school Medicaid programs and the children they serve.
  • April 18, 2017 – the Center on Budget and Policy Priorities releases a report on the impact Medicaid has on schools and children, citing the disproportionate impact the AHCA would have on children and, in particular, those with special needs.
  • March 24, 2017 – House Speaker Paul Ryan pulls the AHCA, which had been scheduled for a vote, because it did not have enough support to pass.
  • March 22, 2017 – the Save Medicaid in Schools Coalition, a national group focused on protecting school Medicaid programs, sends a letter to U.S. House leadership urging them to vote no on the AHCA.
  • March 13, 2017 – the Congressional Budget Committee (CBO) releases its report which estimates that the AHCA would result in more than 24 million uninsured people in the U.S.
  • March 6, 2017 – House Republicans first introduce the American Health Care Act (AHCA). The AHCA would end Medicaid expansion by 2020, kicking millions off Medicaid, and move to a per-capita based funding formula, cutting an estimated $880 million for the program.


Bill Resources
Advocacy Resources
  • Medicaid Helps Schools Help Children; report by the CBPP with facts and figures specific to school Medicaid programs and impact (published April 18. 2017).
  • Medicaid Enrollment by School District; an amazing advocacy resource compiled by the Georgetown Center for Children and Families (released May 19, 2017); the data is also available by county and Congressional district here.
  • NSBA's Issue Brief on the AHCA and its impact on schools & students (published March 21, 2017).
  • CBPP's analysis on why the carve-out for SSI children in the U.S. Senate bill doesn't go far enough to protect disabled children (published June 23, 2017).
  • Follow us on Facebook for alerts regarding coordinated advocacy efforts to defeat the AHCA and save school-based Medicaid programs.