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.

Originally proposed in the U.S. House of Representatives as the American Health Care Act (AHCA), the Republican plan to repeal and replace goes by another name in the U.S. Senate, the Better Care Reconciliation Act (we refer to the Republican plans here as the AHCA for consistency).

The AHCA must clear the U.S. House again, since changes to the original bill were made in the U.S. Senate, and be signed into law by the President prior to implementation.

The Republican health bills propose fundamental changes to Medicaid, including a roll-back of the Medicaid expansion and shift to per-capita funding for states. These changes would cut more than $880 billion from Medicaid, which experts project will lead to tens of millions of people losing health coverage and force states to ration services and reduce access to care.

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 face a serious threat under the AHCA, which would eliminate the federal match and replace it with a fixed amount to cover health care costs for each beneficiary; additionally, the version of the AHCA passed by the House did not account for school-based Medicaid payments in its calculation of the fixed, per-capita, dollar amount.

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), will be on the front lines of those negatively impacted under the AHCA if school-based Medicaid programs cease to provide invaluable funding for school health services.

While the Senate’s version of the health bill includes a carve-out to per-capita funding for children receiving Social Security Income (SSI), there are six times the number of disabled children in schools as their are children who would qualify for the SSI carve-out according to the American Association of School Administrators, leaving millions of disabled children unprotected.

Not unlike the House bill, the Senate’s version of the health bill would subject millions of disabled children to Medicaid cuts, loss of coverage, and threaten school-based health services and programs.


  • 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.
  • 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 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 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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).
  • 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.


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.