New York Assembly Bill A01786

New York 2025-2026 Regular Session

• Introduced: 1/14/25
• Refer: 1/14/25
• Refer: 1/7/26

Caption

Requires the department of health to review claims for expenditures for early and periodic screening, diagnosis and treatment and other health services, care and supplies which are furnished to eligible children and pre-school children regardless of whether such children have handicapping conditions, are suspected of having handicapping conditions or have an individualized education plan; requires the department of health to apply for all necessary federal approvals regarding such expenditures.

Summary

A01786 would expand the Department of Health’s Medicaid claims review and reimbursement authority for certain school-based and county-based health services provided to children. Under current law, reimbursement is tied largely to services furnished to children with handicapping conditions or those suspected of having such conditions. This bill adds early and periodic screening, diagnosis and treatment (EPSDT) and related health services, care, and supplies for eligible children and preschool children, even if they do not have a handicapping condition, are not suspected of having one, and do not have an individualized education plan. The bill also directs the Department of Health to seek all necessary federal approvals to implement these changes, and it makes the new provisions contingent on obtaining federal financial participation. It preserves the existing reimbursement framework through approved Medicaid fee schedules and applies to local public school districts, state-operated and state-supported schools, counties, and New York City, with a special provision allowing certain licensed clinics and diagnostic and treatment centers to directly submit claims in specified circumstances.

Impact

The bill would amend Social Services Law sections 368-d and 368-e to broaden the categories of children whose school-based or county-based health service claims may be reviewed and reimbursed by the Department of Health. It would extend reimbursement eligibility beyond children with disabilities or suspected disabilities to include eligible children and preschool children receiving EPSDT and other health services, care, and supplies, potentially increasing the volume of reimbursable claims and the range of services covered. The bill also requires the department to seek federal approval, and the changes would not take effect unless federal Medicaid matching funds are available, so implementation depends on federal authorization.

Sentiment

The available context shows no recorded committee debate or votes, so there is no documented opposition or support in the provided materials. Based on the bill’s sponsor list and its health-care access focus, the measure appears to be framed as a child health and Medicaid reimbursement expansion rather than a controversial policy change. The absence of votes or transcripts means sentiment can only be characterized as procedurally neutral from the record provided.

Contention

The main potential point of contention is fiscal and administrative: expanding reimbursement to a broader group of children could increase state and local Medicaid claim processing and spending, subject to federal matching rules. Another possible issue is the bill’s dependence on federal approval, which may raise questions about implementation timing and whether the expanded reimbursement will be fully funded. The special direct-claim provision for certain clinics and diagnostic and treatment centers with a less-than-arms-length relationship to a section 4410 provider may also draw scrutiny because it creates an exception to the usual billing structure.