TECH- House moves toward using Medicaid data to enroll families in free and reduced-price lunch program


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[MM Curator Summary]: Automatically enrolling Medicaid kids in free lunch programs moving forward in NH. Right now the argument is whether to have an opt-in model or just do it.



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Allowing Medicaid direct certification could help the state sign up an additional 7,000 students for free and reduced-price lunches who qualify now. (Amanda Mills | Centers for Disease Control and Prevention)

For families making up to 185 percent of the federal poverty level, New Hampshire public schools offer free or reduced-price lunches, a federal program intended to reduce childhood hunger among low-income residents. But first comes an application. 

In order to get the discounted prices for lunches, a parent or guardian must write down the income of everyone in the family – including kids, if they are working – note how often the income arrives, and record any additional payments like alimony or regular support from relatives. Then, the parent must send the application back to the school, whether through their child, in person, or online.

This year, New Hampshire is considering a different approach: Medicaid. A federal program created in 2010 would automatically enroll students in free and reduced-price lunch plans using Medicaid enrollment data. That data includes families’ incomes already, eliminating the need for an application in most cases. 

Last year, Gov. Chris Sununu opted against signing up the state for the program. At the time, he said he wanted the Legislature to direct him to do it in statute. That decision meant that the state cannot participate in the program in the upcoming 2023-2024 school year; the earliest it can participate if it applies to join this year is the 2024-2025 school year. 

This year, lawmakers appear prepared to give Sununu that direction. The House Finance Committee voted to recommend House Bill 601 on Tuesday, requiring the state to enter the program, known as Medicaid direct certification.

Hunger prevention advocates are optimistic. Allowing Medicaid direct certification could help the state sign up an additional 7,000 students for free and reduced-price lunches who qualify now, said Laura Milliken, executive director at New Hampshire Hunger Solutions. That change could make a meaningful difference to many lower-income students’ nutrition, she said. 

“It’s disappointing to us that we couldn’t get it done sooner, but we’re hopeful that it does get done because people are having a hard time right now,” Milliken said in an interview. 

But House Republicans have also added an amendment to the bill that would require participants to opt in to the direct certification program, an addition that would make New Hampshire’s program unique among the 39 states that currently participate. 

“We are opposed to opt-in language and worry that it would not be consistent with the goals of the Medicaid direct certification pilot program,” Milliken said. “Thirty-nine other states are participating in the pilot program and none of them uses an opt-in.” 

Still, Milliken said the organization is supporting the broader bill. 

For many families that meet the income requirement for free and reduced-price meals – up to $55,000 per year for a family of fourentering the program can be a major boost; children receiving reduced-price meals pay 40 cents for each lunch, compared to up to $4 per lunch for those not qualifying. But not every family applies, and schools must adopt strategies to persuade them to participate. 

Proponents say joining the Medicaid direct certification program would help school districts recoup more money from the federal government for their meal programs. It would also lead to a more accurate count of the number of students receiving free or reduced-price meals, a key number that determines how much each district receives in state adequacy funding.

States are barred by federal law from accessing their residents’ Medicaid data without express permission. The Medicaid direct certification program grants that permission to the states that have enrolled. 

But some Republican lawmakers have voiced skepticism over entering the state into the program, a move they said could subject the state to more federal rules. Instead, those opponents have suggested finding ways to utilize the state’s Medicaid data without federal involvement. 

“Though the necessity of providing funding for an adequate education is clearly a matter of interest to this committee, so too is our duty to jealously guard our state sovereignty,” wrote Rep. Arlene Quaratiello, an Atkinson Republican.

Supporters say the program would provide schools a new tool to help students whose families may not be signing up for free and reduced-price lunch due to lack of awareness, forgetfulness, or stigma. Some kids and families are reluctant to sign up, fearing embarrassment at school, advocates say.

The issue gained new urgency last year, when a COVID-era temporary federal initiative came to an end that allowed all students to receive meals at school, regardless of income. That change forced schools to kick off awareness campaigns to remind parents that they now needed to apply for free and reduced-price lunches if eligible.

“In most school districts, free and reduced meal participation is still down,” Milliken said, comparing current numbers to pre-COVID-19 numbers. “You have to think about the fact that there are families whose kids started school during the pandemic who didn’t know that there was (an application) because they didn’t need to apply for free and reduced-price lunch.”

She added: “I think schools are doing their darndest to get people to know if they can sign up, but I think it underscores why something like Medicaid direct certification is so important, because people at this moment in time have so much on their plates.” 

The amended bill must survive a vote on the House floor next week, as well as the Senate process. A bipartisan group of senators endorsed the idea last year, indicating that there could be support this year. But a number of new senators have entered the chamber since the last election. 

Speaking to the House Finance Committee in March, Sununu said he had set aside $30 million in his proposed budget to fund the administration of the Medicaid direct certification program in New Hampshire. But he again left it to lawmakers to approve the creation of the program in state law.

“You can debate whether you should or shouldn’t do that,” Sununu said. “My budget builds in the opportunity that if you do that, it’s all good.”

Addressing Sununu, Rep. Mary Heath, a Manchester Democrat, showed appreciation for the new stance. “I think that’s a win-win for our state, and I’m certainly hoping that this body will go along with that.”