Twenty years after Congress passed the Medicare Catastrophic Coverage Act, the Bush administration is continuing its assault on a program that helps school districts and BOCES meet the spiraling costs of federally mandated special ed services with reimbursements from Medicaid.

Last month, CMS, the federal government's Centers for Medicare and Medicaid Services, issued final regulations that would eliminate Medicaid reimbursement for some services provided to students with disabilities - transportation among them - in the 2009 federal fiscal year.

Congress did vote to impose a six-month moratorium on the measure, buying time for NYSUT and other supporters to continue efforts to save services that CMS described in these latest regulations as "not necessary for the proper and efficient operation of the Medicaid state plan."

If the ruling remains once the moratorium is lifted, school transportation costs for students with disabilities must be directly linked to medical services to be eligible for Medicaid reimbursement.

Earlier this month, the state Office of the Medicaid Inspector General issued a "Medicaid in Education Alert" to school providers, warning of widespread denials of claims for reimbursement for speech therapy, counseling and special transportation.

As these policy maneuvers play out, NYSUT is seeking to overturn a 2007 directive from CMS that calls into question the qualifications of New York state-certified school counselors, school psychologists, school social workers and certified speech teachers.

The directive effectively denies Medicaid reimbursement to schools for counseling services specified in a student's Individu-alized Education Program unless those services are provided by licensed professionals "whose credentials allow that same service outside of the school."

Requiring school services be provided by licensed psychologists is unrealistic and hinders a district in providing mental health services, according to the president of the New York Association of School Psychologists.

"The available professionals in the community do not match the demands of school," said John Kelly, a member of the Commack Teachers Association. According to the State Education Depart-ment's Office of Professions, 35 of New York's 62 counties have 20 or fewer licensed psychologists; and two have none.

Humiliation

Speech teachers who are not licensed may provide Medicaid-reimbursable services, but only "under the direction of" a licensed speech language pathologist.

"It is professionally humiliating and demoralizing," said Ellen Skalka, who was certified 34 years ago as a teacher of the speech and hearing handicapped.

Now, ignominiously identified by Medicaid as the "least qualified providers," teachers like Skalka - who has taught at Nassau County BOCES 22 years - can no longer sign off on their reports.

They must undergo formal observations by a supervising speech language pathologist multiple times during the school year for each student in their caseload.

"It's totally invasive and detrimental to the therapeutic environment," said Skalka, a member of Nassau BOCES Central Council of Teachers. Her progress with autistic students is easily upset by visitors and disruptions in routine.

The problem, as she sees it, is that the federal government is arbitrarily imposing a medical model on an educational model.

That educational-vs.-medical sentiment is reflected in a resolution NYSUT's Board of Directors has approved for action by delegates to the union's Represent-ative Assembly in April.

The resolution calls on the state ed and health departments to work with CMS to reverse its requirement that Medicaid-eligible services be provided only by licensed personnel. It would also commit NYSUT to working with national affiliates to lobby Congress for a reasonable reimbursement process.

Medicaid currently reimburses about 8 percent of the amount New York school districts pay for special ed services. NYSUT officials are concerned about districts and the 37 Boards of Cooperative Educational Services being unable to count on Medicaid reimbursements as they prepare their budgets for the coming school year.

"The federal government's failure to provide Medicaid reimbursement," said NYSUT Vice President Maria Neira, "is another breach in a promise made in 1975 to fully fund the excess cost of special education services."

That federal promise involved services required under the then-new Individuals with Disabilities Education Act. IDEA still guarantees that students with disabilities receive a free and appropriate public education in the least-restrictive setting, based on needs in a student's Individualized Education Program.

"Our best chance to resolve this problem is to either get the federal Medicaid office to reverse its position or for Congress to pass legislation that would nullify the federal government's policy," Neira said. But that's unlikely, she added, "until there is a new administration in Washington." NYSUT, she said, will work with state officials and its national affiliates to stop Washington from limiting the state's right to determine the qualifications of its certified providers in schools.

- John Strachan