Senator introduces bill to require parental consent for Medicaid-billed school services; districts, health centers warn of administrative burden

Senator Ruth Ward introduced Senate Bill 34, saying the measure would require schools to obtain parental consent for each new service provided to a student under the Medicaid-to-Schools program and would require legislative policy committees to receive program reports.

The measure, Ward said, "is intended to provide transparency, protect parental involvement, and ensure that a continuity of care is provided to adolescents and young adults." She told the committee the bill grew from the Committee to Study Consent and Confidentiality Laws Applicable to Adolescent and Young Adult Health Care in New Hampshire.

The change prompted sharply divided testimony during the hearing. Sean Parr, chair of the Manchester School Board's Education Legislation Committee, said SB 34 would "greatly increase administrative labor and could jeopardize students receiving timely services," especially for families with language barriers, work constraints, or housing instability. Parr said Manchester Public Schools has about 12,000 students and roughly 3,000 students with individualized education programs (IEPs), and that requiring repeated signed consents each time an IEP is amended would be difficult to implement and could interfere with timely billing and budgeting.

"If a Medicaid student first needs speech therapy, then midyear needs physical therapy, then later specialized transportation, they should receive those services, and we should be able to bill Medicaid without needing three separate parent consent forms," Parr said. He warned the bill could force districts to wait until the end of the school year to reconcile Medicaid billing and would shift costs to local taxpayers if federal Medicaid reimbursements fall.

Representatives of community health centers echoed those concerns. Christine Stoddard, who represents federally qualified health centers across the state, said her centers serve more than 100,000 patients (about 20 percent children) and rely on Medicaid reimbursements. She said the bill as written would impose administrative burdens that could delay or reduce care.

Betsy Burdes, chief operating officer of Amoskeag Health in Manchester, said the proposed language could require a new parental release any time an ICD‑10 diagnosis or billing code changed — even when treatment stayed the same. "To get a release every single time that diagnosis changed... would be extremely burdensome and would hold up services to our kids," Burdes said, citing mental‑health and acute care examples.

Supporters of SB 34 and parental‑rights advocates argued the bill would add oversight and protect families from erroneous billing or unauthorized evaluations. Anne Marie Banfield, a parental‑rights advocate, cited out‑of‑state media reports and investigations she said showed school Medicaid billing can draw scrutiny and that a parental review could catch mistakes before they turn into fraud investigations. "Parents reviewing these accounts offer another layer of protection when it comes to mistakes," Banfield told the committee.

Other witnesses sought compromise language. Becky Wilson of the New Hampshire School Boards Association said the association was not taking a position at the hearing but urged the committee to coordinate any statutory changes with the Department of Health and Human Services (DHHS) rollout of Medicaid‑to‑Schools billing changes planned for the 2026–27 school year, including training and forms. Wilson warned that a midstream change in consent paperwork could create implementation issues and risk audit findings that require districts to repay federal funds.

Several legislators pressed witnesses on practical points: how parents are currently involved, how services change during the school year, and whether parents have avenues to dispute services. Witnesses said parents generally participate in IEP and 504 meetings but that some parents are difficult to reach and that urgent or evolving needs sometimes require timely treatment and corresponding billing.

The hearing produced no vote; the committee recorded testimony and collected suggested language and technical comments. Witnesses asked the committee to work with DHHS and stakeholders on precise drafting to avoid per‑visit consent triggers tied to billing codes.

Ending

Committee members asked stakeholders to submit proposed statutory language that would protect parental involvement while avoiding frequent, code‑driven consent requirements that could disrupt care and billing. The hearing record closed with the chair noting sign‑in sheets and that written suggestions could be submitted for the committee's consideration.