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Republican lawmakers balk at Medicaid Direct Certification program, citing cost and privacy

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Republican lawmakers balk at Medicaid Direct Certification program, citing cost and privacy

Nov 08, 2023 | 5:00 am ET
By Ethan DeWitt
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Republican lawmakers balk at Medicaid Direct Certification program, citing cost and privacy
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Medicaid Direct Certification, a U.S. Department of Agriculture program that states can choose to join, allows school districts to use Medicaid data to determine which of their students already qualify for free or reduced-price meals, without needing to contact parents. (Amanda Mills | Centers for Disease Control and Prevention)

A push to automatically sign up New Hampshire students for free or reduced-price lunches if they are enrolled in Medicaid is facing a setback, after Republican lawmakers voted to not recommend the move, citing privacy and cost concerns.

Medicaid Direct Certification, a U.S. Department of Agriculture program that states can choose to join, allows school districts to use Medicaid data to determine which of their students already qualify for free or reduced-price meals, without needing to contact parents. 

Advocates note that nearly 8,000 K-12 students could receive free or reduced-price meals but don’t, according to state Medicaid data, and say automatically enrolling them could benefit their health and their family’s finances.

But in a report released Nov. 1, Republicans on a study committee looking at the issue wrote that sharing the Medicaid enrollment information with schools without the explicit permission of parents would be a privacy violation. 

“The majority believes changing the law and moving to MDC … would subvert the parent’s current choice not to enroll and share data with (the Department of Education),” the report said. “That mandate we feel is against the spirit of the constitutional amendment that protects New Hampshire citizens’ personal and private data from intrusion from the state.”

Republicans also said that doing so would be too costly, requiring the state to spend about $95 million more per year to accommodate the increased tallies of free and reduced-price lunch students. 

Adding new students to the free and reduced-price meals program does not itself cost schools money; the USDA reimburses schools for the costs from additional students. But because the state’s school funding formula is tied to the number of free and reduced-price lunch students in each district, the change indirectly affects state education funding. 

Instead, Republicans proposed an alternative: adding a box to the state Medicaid application to allow parents to automatically opt their children into the meals program. 

Laura Milliken, executive director of New Hampshire Hunger Solutions, expressed frustration.

“It seems like we should be taking every opportunity to streamline the process and make it easier for families with children,” she said in an interview. “To make sure that all children are getting the nutritional support they need to thrive.”

Under the federal school lunch program, students whose families earn up to 185 percent of the poverty level are eligible for discounted meals; those whose families earn up to 135 percent may receive the meals for free. But currently, New Hampshire parents must fill out a form in order to opt in to those free or discounted meals. 

Medicaid Direct Certification would allow the schools to skip that opt-in for students whose incomes they know due to Medicaid data – families making up to 138 percent of the federal poverty level may enroll in Medicaid or Medicaid expansion. 

Written by top House and Senate lawmakers, the report is likely to be influential as the Republican-led Legislature considers proposals to join the program in the coming months. 

Signing the majority report were Sen. Timothy Lang, a Sanbornton Republican and the chairman of the Senate Education Committee, and Carrie Gendreau, of Littleton, as well as Republican Reps. Alicia Lekas, of Hudson, and Daniel Popovici-Muller, of Windham.

Democrats on the study committee broke with the majority, filing their own report endorsing the idea.

“Addressing childhood hunger should be the top priority for every elected official in New Hampshire,” the minority report reads. “… MDC would not only benefit the health of New Hampshire children by reducing hunger, it would eliminate unnecessary administrative bureaucracy for state agencies, schools, and families.”

Rep. David Luneau and Sen. Rebecca Whitley, both of Hopkinton, signed the Democratic report.

Advocates for the program say some parents are unaware of the need to fill out the form to receive the discounted lunches, or are negligent in doing so. Others may feel a stigma associated with the program, which could prevent some parents from filling out the form and some kids from nudging their parents to do it, they say. 

And they have dismissed the privacy concerns about data sharing, noting that those families on Medicaid have already shown they are comfortable sharing their data with the state health department. 

The issue has become a political football in recent years. Lawmakers shelved an effort by anti-hunger advocates and Democrats to add the measure to the budget earlier this year; the study committee was formed to examine budgetary concerns. 

Department of Health and Human Services and Department of Education data reveals that 7,721 more kids could be enrolled in the free or reduced-price lunch program should Medicaid Direct Certification be put into effect, according to the Nov. 1 report.

Adding those new students to free and reduced-price meal programs would require the state to pay more to those schools. New Hampshire’s funding formula allocates more money to schools that have higher populations of free and reduced-price meal students. 

If all 7,721 students joined the program, it would cost the state $190.3 million over two years in additional adequacy aid to schools, according to the legislative report. That would represent about a 10 percent increase in education spending in New Hampshire; the state spends just over $2 billion on education every two years.

Part of that high price tag comes from the fact that the Legislature retooled the state’s education trust fund in the budget this year to give school districts more funding for free and reduced-price lunch students, Lang said in an interview.

In their report, Lang and other Republican lawmakers noted that the state already increased its education funding by $193 million over two years in the latest biennial budget, passed in June. They added that no funding source has been identified to pay for another $190 million jump.

Lang said families that sign up for Medicaid and divulge their income level to the Department of Health and Human Services may not feel comfortable sharing that same information with the Department of Education or to their school district. 

He said he wouldn’t be opposed if parents of the 7,721 students all signed up simultaneously – even if it created budgetary problems – but said the state should not force that to happen.

“We’re not saying we don’t want them to have it,” he said. “What we’re saying is, they’re given the choice now to do it. We want to keep that choice in place.”

He added: “If they exercise that choice, we’ll figure out where the money comes from.”

To Milliken, though, the privacy concerns are misplaced; children whose families are enrolled in the Supplemental Nutrition Assistance Program already automatically qualify for free and reduced-price lunches in schools, she noted, which already requires data sharing. 

And Milliken argued that the Legislature should not block the automatic enrollment program just because the state’s funding formula is tied to free and reduced-price lunches.

“It is especially disappointing because the Medicaid Direct Certification itself really doesn’t cost anything,” she said. “It’s not the cost of the meals, which are covered by the federal government. It’s the funding formula.” 

Lawmakers will continue to debate the issue; the House Finance Committee is continuing to work on House Bill 601, which would enroll New Hampshijre in the program.