The final weeks of this year's legislative session in Frankfort were intensely focused on finding a solution to the lack of funding for the Medicaid program. Gov. Steve Beshear's preferred remedy is to utilize a managed care plan to administer the program across the state. While this may be an important part of managing health care for the most vulnerable citizens, an important safety net was lost in the discussion — the school nurse program.
KRS 156.502 requires that school districts provide school health services and defines health services including administration of medications; operation, maintenance or health care through use of medical equipment; and administration of clinical procedures.
It does not detail how school health services are to be administered (local school district decision). In fact, there are several ways in which school districts choose to provide these services. The most efficient of these is the model chosen by the Hopkins County School System, Dawson Springs Independent Schools and the Hopkins County Health Department.
Under this model, the school system contracts with the local health department to provide nurses and clerks. The nurses provide Early Periodic Screening Diagnosis and Treatment exams and immunizations for children who are on Medicaid as well as traditional nursing care for illness and injury.
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The local health department bills Medicaid for the care provided for students with Medicaid under the Medicaid Preventive Care Program. Currently, the federal government pays 80 percent of Medicaid and the state is responsible for 20 percent. This revenue fully funds the school nurse program. The schools help to provide the clerks.
However, in all counties that participate in the Medicaid Preventive Program, the health departments pay the state's 20 percent so it does not cost the state any money to provide nurses in the schools. Likewise, it costs the school system a minimal amount at a time when funding for schools is critical.
At issue is the fact that Passport, the state's Medicaid managed care program, does not reimburse local health departments through Medicaid for the exams or preventive health provided in schools. If the governor's new managed care plan copies Passport, we will lose all of our school nurses in just a few weeks.
What's worse is that this program serves almost half the Medicaid patients in Hopkins County. It saves the state even more money by intervening in a setting where the local health department pays the 20 percent match instead of having sick kids flood the emergency room where the state pays the match.
Several representatives and senators voiced concerns as budget negotiations moved into a special session. Language was drafted and given to leadership to be included in the final compromise. Despite their efforts, it didn't make it in.
As it stands, the legislators have done all we can to preserve the school nurse program. I have spoken to Secretary Janie Miller of the Cabinet for Health and Family Services, but it is the governor who has complete discretion in the formation of his managed care plan.
I want to acknowledge Hopkins County Health Department Director Jack Morris and his Director of Nursing Denise Baldwin. Their program is a very efficient model that would benefit our state.
Enormous credit also goes to Superintendent James Lee Stevens, Superintendent Alexis Seymore and their respective boards of education for adopting this cost-saving program. They are the truest ambassadors for the cost-efficient school nurse program.
It is my hope that, as the governor considers his managed care program, he will include this plan that saves money in Medicaid, saves money in education and provides a safety net for the commonwealth's most vulnerable citizens.