A new survey of school district leaders across the country finds that they are deeply worried that Republican proposals to refinance Medicaid, if they become law, would hurt students who live in poverty and those with disabilities and in special education.

A big cut in Medicaid spending would mean, the survey report said, that many districts would have to furlough or lay off school personnel, that the percentage of uninsured children could go from 12 percent to an estimated 21 percent or higher, and critical benefits could be eliminated. Furthermore, new local tax levies or requests for higher taxes could result in an effort to make up for lost funding to special education programs and health services for students in poverty.

Nearly 40 percent of children in the United States receive their health care through Medicaid, according to AASA, the School Superintendents Association which did the survey, titled “In Cutting Medicaid: A Prescription to Hurt the Neediest Kids.” It was administered by the AASA as well as the Association of School Business Officials International and the Association of Educational Services Agencies.

Republicans have long been eager to refinance Medicaid, the program in which the federal and state governments share the cost of helping to cover medical costs for millions of disabled and low-income Americans. The election of Republican President Trump has spurred Republican legislators in Congress to move toward an overhaul. Here’s how this Washington Post story describes what they are interested in doing to Medicaid:

But many key Republicans are especially interested in changing Medicaid, the nation’s health insurance program for the poor — including Trump, House Speaker Paul D. Ryan (Wis.) and Tom Price (Ga.), Trump’s nominee to head the Department of Health and Human Services. Each of those three has proposed converting Medicaid from a program funded jointly by the federal government and the states into a block grant program. Doing so would send a set amount of money to each state, thus capping total Medicaid spending, and would let each state decide how to disburse those funds. … Historical data suggest that a shift to block grants would result in a gradual decline in Medicaid funding. A 2016 report by the Center on Budget and Policy Priorities (CBPP) showed that when the federal government uses block grants, the funding for the programs shrinks over time.

The AASA survey noted that Republicans have said they want to cut Medicaid spending by 25 percent through the block grant or a per capita cap, though other estimates say that it could be 30 or 35 percent in the long-term. The survey asked school district leaders a number of questions related to Medicaid, including how they spend Medicaid dollars.

Here are some of the results. They include a reference to Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, which is the child health component of Medicaid:

• Respondents overwhelmingly expressed concern that students in special education programs will be negatively impacted if a 30 percent Medicaid reduction were to occur. Specifically, there are concerns about the ability of districts to maintain special education program quality and meet federal mandates.
• Respondents were deeply worried about how students in poverty will be impacted if ESPDT services are no longer reimbursable. School leaders were distressed by reductions to general education personnel and programs that would be necessary to make up for the shortfall in reimbursement for special-education programs. Respondents also expressed concern with the economic impact of Medicaid cuts.
• As one of the largest employers in the community, districts would have to furlough or layoff school personnel who are paid for, in part or entirely, through Medicaid reimbursement.

AASA says that it asked a nationally representative sample of public school district superintendents and received nearly 1,000 responses from them, as well as some from assistant school superintendents, school business officials, special education directors and education service agency leaders from 42 states.

The report urges U.S. legislators “to weigh how children will be impacted by a Medicaid block grant and to reach out to school leaders for specific insights about the importance of their school-based Medicaid programs for students.”