The House Republican plan to replace Obamacare makes significant cuts to Medicaid, and critics are warning those reductions could affect some of the nation's most vulnerable people, children with disabilities.
Advocates for people with disabilities have long claimed the federal government short changes special education funding. Now, they worry that Medicaid money that makes up a small but important part of special education budgets will be lost or reduced as a result of the House bill, which passed on a 217-213 vote two weeks ago.
Much of the attention paid to the American Health Care Act has been on the changes it would make to the Affordable Care Act's provisions. But the legislation also changes how the Medicaid program is funded.
The bill would establish a cap on funding that would base expenditures in each state on last year's average enrollee costs. That cap would rise with inflation, but it would be a big difference from the way the program is funded today.
Currently, Medicaid, whose costs are shared by the federal and state governments, pays for certain covered services as long as enrollees are eligible.
The Congressional Budget Office estimated the House measure, as it was introduced, would lead to $880 billion in cuts to the program over 10 years. That includes phasing out expansion of the program that came under the Affordable Care Act.
Earlier this month, the School Superintendents Association, a Virginia-based organization that represents school leaders around the country, warned that "a per capita cap, even one based on different groups of beneficiaries, will disproportionately harm children's access to care, including services received at school."
In a recent interview, Sen. Tammy Duckworth, D-Illinois, called the potential cuts "deeply, deeply troubling."
Republican critics say Medicaid is overextended. They say their plan will ensure the long-term viability of the program, preserving it for people who need it the most.
In the Quad-Cities, school administrators say the Medicaid money helps pay the cost of teachers, para-educators and nursing staff.
Special education classes often require a larger number of staff to meet their students individual circumstances. "Those students have great needs," said Patti Pace-Tracy, director of special education for the Davenport district.
In Davenport, that $3.3 million is part of a $30 million special education budget.
In Bettendorf, the district gets anywhere from $700,000 to close to $1 million in Medicaid funding, about 10 percent of its special education budget.
Losing that money "would be very difficult," said Kay Ingham, director of student services for the district.
At Earl Hanson Elementary School in Rock Island, about a dozen third and fourth graders were working in a special education class Monday on math and other skills. Dan Logan, the principal, said the school has about 90 special education students. Meeting their needs, which can include social, emotional and transportation requirements, can put a strain on finances.
"We would always love to have more," Logan said.
Nationwide, about $4 billion in Medicaid dollars are spent on supporting special needs students in school classrooms. That's a small part of the approximately $545 billion spent on Medicaid in 2015. But it is a significant federal involvement in light how how much Washington, D.C., spends on meeting the requirements of the Individuals with Disabilities Education Act, or IDEA, the main federal law governing special education. Last year, the federal government spent $16 billion on IDEA, an amount advocates for students with disabilities have long complained is too low.
School officials say that even if Medicaid funds are lost, IDEA, as the federal law is called, requires that they still maintain services. In other words, districts won't just cut programs because of Medicaid reductions. Instead, they say they'll have to find it elsewhere. "We still have to continue to do that regardless of whether the funding is there or not," Pace-Tracy said.