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Before her third birthday, Addie Ellis was diagnosed with a rare disorder known as Rubinstein-Taybi Syndrome. Despite being nonverbal, Addie, who’s now 13, has always been with her peers, learning alongside them in a regular classroom.

“She has shown us things that really, as a nonverbal child, it would be easy not to ever have pulled those things out,” said her mom, Terri Hart-Ellis.

At her school in Milwaukee, Addie has a one-on-one aide, and, over the years, has also received services like physical, occupational and speech therapy. For decades, school districts have relied on Medicaid to help cover costs for special education services like those and more.

“Vision screenings, hearing screenings, managing their asthma and diabetes,” adds Sasha Pudelski with the School Superintendents Association. She said Medicaid gives school districts up to $4 billion a year.

Cuts to Medicaid have been at the center of the fight over health care, and one little-noticed target would be schools. When lawmakers return to Washington, D.C., next week, they’ll pick the issue back up. Both the House and Senate’s current plans would cut Medicaid spending to the poor and disabled by hundreds of billions of dollars.

“It’s going to be impossible to imagine a scenario with less money from the federal government, school districts being able to maintain reimbursement,” Pudelski said.

And districts are required to provide special ed services. So to make up for losses, some superintendents said they might have to cut back on nurses or after-school programs like art and sports.