House Committee Hears Push to Tie Parental Consent to Medicaid-to-Schools Care plans

Senate Bill 34, which would require parental consent whenever a student's Medicaid-to-Schools care plan is created or changed, drew hours of testimony at a House Education Policy and Administration Committee hearing.

Sen. Ruth Ward, R-8, the Senate sponsor, told the committee the bill would "provide transparency, protect parental involvement, and ensure continuity of care" for adolescents and young adults who receive medically related services in schools. Ward said the change responds to concerns after federal proposals in 2023 that, she said, could have removed parental consent requirements for some services.

Supporters and opponents agreed on one central change: the amendment presented to the committee replaces the bill's original trigger—changes to a billed ICD-10 service code—with a requirement to obtain consent for a new or updated care plan. Christine Stoddard, representing Bi-State Primary Care Association, and Betsy Burdes, chief operating officer at Amaskeag Health, told the committee that tying consent to diagnosis codes would be administratively unworkable and could force providers to interrupt appointments mid-visit to obtain signatures.

"A code could change from the time you start the appointment to the end of the appointment," Burdes said, describing an example where a student is assessed for depression but anxiety is also raised during the visit. She said the amendment's care-plan approach aligns with current clinical practice and would prevent unnecessary pauses in services that could burden families and delay care.

David Chorney, deputy Medicaid director at the Department of Health and Human Services, described the operational reasons DHHS prefers linking consent to a care plan rather than individual ICD-10 codes. He noted there are more than 70,000 ICD-10 codes and that codes change over time; Chorney said program-integrity guidance sometimes directs providers not to bill particular codes because of how services should be delivered.

"Basing it off the care plan is more operationally feasible," Chorney said. He added that state law already requires parental consent for participation in the Medicaid-to-Schools program and for annual billing, and said the bill's effect would be to make explicit in statute that changes to a care plan adding a new service require parental consent prior to performing that new service.

Representatives from the New Hampshire School Boards Association and from Amaskeag and other community health centers described Medicaid-to-Schools as a complex, heavily audited program that many districts manage with outside billing vendors. Becky Wilson of the School Boards Association said participation requires schools to document the medical necessity of services in an IEP, secure parental consent to disclose that a child receives medically necessary services, and confirm Medicaid eligibility. She described the program's paperwork and the modest per-service reimbursements that, aggregated over time, help districts offset costs.

Advocates for keeping parental involvement noted local variations in how services are provided. Committee members asked whether services provided at home (for example, when a child is homebound) could be billed under Medicaid to Schools; DHS said certain school-based services could be delivered at home and billed under the program, while unrelated provider visits outside the school setting would not be covered by Medicaid to Schools.

Committee members asked several times whether the bill meaningfully changes existing state law. Chorney and witnesses said parental consent is already required by statute and for annual billing; the bill would make explicit the need for written consent when a care plan changes to add new services.

Questions from members focused on operational impacts: who does the billing when an outside provider works in a school (the provider, the health center, or the school can bill depending on employment and contracting), how often consent would need to be re-sought, whether IEPs always include individualized health plans, and whether the amendment in the packet aligns with language in House Bill 2. Witnesses said the amendment clarifies when written consent is required and that DHHS and the Primary Care Association proposed the amendment language shortly before the hearing.

No formal vote was taken at the hearing. Committee members said they would review HB 2's language and consult with the sponsor and DHHS before next steps.