The American Health Care Act and Public Education

Medicaid & Schools

Since 1988, schools and districts have been eligible to receive Medicaid payments for medical expenses they incur for providing services to students with disabilities under the Individuals with Disabilities Education Act, or IDEA, and for providing services such as health screenings, vaccinations, and behavioral health services to Medicaid-eligible children through Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT.  In many cases, this includes services covered by Medicaid, such as speech therapy and occupational therapy.

Although these services amount to only 1 percent of Medicaid’s annual budget, they are a significant portion of federal funding for schools, providing approximately $3 billion each year in federal funds. As a point of comparison, total federal funding for IDEA is $13 billion. Cuts to Medicaid would limit cash-strapped schools in their ability to meet the needs of special education students.

Medicaid Cuts and Tennessee’s Budget

Over 20¢ of every dollar in TN’s state budget is federal Medicaid funding. Proposed federal Medicaid cuts in the American Health Care Act (AHCA) of $500 million per year, increasing in future years, are too big to handle with TennCare cuts alone.

Without the federal oversight that comes with federal Medicaid spending, Tennessee would be left to its own devices to handle the funding cuts. The result could be raising taxes to make up the shortfall, cutting services to poor and special needs students, or taking money from other programs in the state’s budget. ALL aspects of the state budget, including K-12 and higher education, could sustain cuts.

Medicaid Cuts and Tennessee’s Schools

Although Tennessee’s Medicaid program is a small percentage of federal Medicaid spending, an estimated $500 million dollar cut to our program would trickle down, jeopardizing the $51 million dollars that schools receive.  According to a recent survey of nearly 1,000 school and district leaders from 42 states, 68 percent of respondents use these Medicaid reimbursements to pay for the salaries of school-based health professionals, including school nurses, school counselors and psychologists, school-based physical therapists, and speech-language pathologists. The drastic cuts to Medicaid included in the AHCA could mean major cuts to these critical personnel and would ultimately hurt students of all income levels and abilities.

What can you do?

Meet with our senators. Senators Alexander and Corker are key to passage of the AHCA. Let them know that you are worried about the effects of the AHCA on Tennessee’s schools through in-person meetings, phone calls, emails or handwritten letters. If you would like more information or help with contacting our Senators, please visit



How the American Health Care Act Hurts Children of Color

Five million kids, including 112,402 children in Tennessee, could lose federal Medicaid eligibility under the U.S. House-passed American Health Care Act (AHCA), which would repeal the Affordable Care Act. Of these children, Black and Hispanic children are disproportionately affected. A study conducted by the Institute for Child, Youth and Family at the Heller School for Social Policy and Management at Brandeis University analyzed the effect of ACA repeal on school-age children, including children of different racial/ethnic groups.

A provision of the Affordable Care Act raised the federal income eligibility for Medicaid from 100 percent of the federal poverty level (FPL) to 138 percent FPL. For a family of 4 in Tennessee in 2017, this means that before the ACA, their children’s threshold for qualifying for TennCare would have been $24,600 and now under the ACA, it is $33,948. Even a relatively modest rollback of federal income eligibility to pre-ACA levels under the AHCA, from 138 percent down to 100 percent FPL, would have a sweeping impact for children ages 6 to 19.

Across the nation, about 14 percent of Hispanic children and 12 percent of Black children currently covered by Medicaid would become ineligible under the American Health Care Act. In Tennessee, children of color will be hit especially hard by the AHCA.

Under the American Health Care Act, Tennessee would have the largest decline in the percentage of Hispanic children eligible for Medicaid across the entire United States.  If the Medicaid income eligibility threshold was changed from 138% FPL back to 100% FPL, the decline in the percentage of Hispanic children eligible in Tennessee would be 20.4%, which is approximately 18,672 children.

Tennessee is also in the top ten for the highest percentage of Black children who would lose coverage under the American Health Care Act. The decline in the percentage of Black children eligible in Tennessee would be 14.4%, which is approximately 29,971 children.

The report also shows an additional 59,961 White children (8.3%) and 3,798 children of two or more races (9.6%) would lose coverage under the changes in eligibility levels under the AHCA.

Brandeis Report Graphic

Currently, Medicaid provides critical care to low-income school-aged children. It helps ensure that kids have coverage and in turn, they miss fewer days and perform better in school, are more likely to finish high school, attend and graduate college, and earn more as adults.

Medicaid does this by providing school-age children access to vital preventive services including vision screens, immunizations and other important screens related to developmental success through Early and Periodic Screening, Diagnosis and Treatment (EPSDT). 68.6% of superintendents say they use their Medicaid dollars to fund positions, such as school nurses and speech therapists, to meet the requirements of the law and aid children with special health care needs.

Medicaid is a key tool for advancing health equity. Reducing the minimum federal eligibility threshold for school-age children would exacerbate disparities in health outcomes. Additionally, the drastic $834 billion cut to Medicaid will result in lower provider rates, reduced access to care predominately in communities of color and low-income communities and separate and unequal health care systems.