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Metro Health warns San Antonio oral health services risk losing Medicaid 1115 waiver funding
Summary
Metro Health told the Community Health Committee that the Medicaid 1115 waiver that funds much of the city's school-based oral health work will expire Sept. 30; staff said they have not yet identified replacement funding and asked the council to consider options during FY27 budget planning.
Metro Health staff told the San Antonio Community Health Committee on Feb. 2 that the city's school-based oral health programs face a substantial funding risk when a Medicaid 1115 waiver reserve expires on Sept. 30.
Dr. Jacob, a Metro Health official, said the waiver currently anchors roughly $1.4 million of program funding and supports most operational positions for the oral health portfolio, and that the Miles of Smiles school-clinic operational budget is funded by that waiver. He warned staff are evaluating options for sustaining services and will present analysis as part of the FY27 budget process.
The warning followed public comments from three long-time local providers. Beatrice Hicks, a retired associate professor at UT Health San Antonio, described a 2006 collaborative grant (about $300,000 in her remarks) and the Head Start-focused preventive model that includes screenings, fluoride varnish and case management. Lydia Almaris, a retired Head Start family and community specialist who said she worked in the program for five decades, called the Metro Health partnership a "lifeline" and urged the committee to continue the contract. Retired dentist David Singleton described treating children in school clinics and said many students present with untreated decay and pain after pandemic disruptions.
Committee members pressed staff for details. Councilmember White asked whether replacement funding had been identified; staff said not yet. White and others sought a clearer budget breakdown: Metro Health indicated general-fund support is a minority share (staff cited roughly 16% of the program budget and committee discussion referenced about $400,000 from the general fund), with the remainder drawn from the Medicaid 1115 waiver and external grants. Dr. Jacob said Metro Health is "shaking every tree" for other grant opportunities but had no confirmed replacements at the time of the briefing.
Committee members also questioned program reach and equity. Staff said the Miles of Smiles clinics operate in participating elementary schools across eight districts and that the program focuses on Title I schools, which explains why districts with fewer program sites can still show high percentages of urgent need: the program purposely targets students at highest need. Metro Health reported it reached more than 17,000 children last school year; among those screened, about one-third showed untreated decay and about 5% displayed signs of urgent dental need (for example, abscess or infection) at the time of exam.
Staff offered follow-up materials and next steps: Metro Health will provide a memo with a site-by-site breakdown of Miles of Smiles locations, a marketing/outreach budget breakdown on prevention efforts and additional data on program outcomes and referrals. Justina Tate, interim assistant city manager, said the waiver-loss scenario was included in a recent tabletop exercise and that a formal report with additional analysis will be provided to the committee in February.
The committee did not take formal action on the program at the meeting; staff said budget planning documents and FY27 discussions will include analyses of options to sustain or downscale components of the oral health program.
