Millions of education dollars are being spent delivering healthcare in Oregon classrooms – but schools can’t bill private insurance when their nurses and staff administer insulin to a student or work with a child’s complex medical needs. And administrative burdens make billing Medicaid a daunting process.
Policymakers, advocates and practitioners gathered at Portland’s Multnomah Athletic Club on Wednesday morning to advance the conversation at “Bridging the Gap Between K-12 Education & Healthcare.” The panel discussion and breakfast gathering was put on by the Oregon Health Forum, and moderated by Kelly Jensen, managing director of Compelling Reason Consultants. (The Oregon Health Forum is the educational branch of the The Lund Report.)
Though from diverse backgrounds, the panelists were unified in their support of efforts to boost Oregon’s pursuit of federal Medicaid reimbursements by schools. The discussion came just as efforts by the state get underway to launch nine pilot projects aimed at boosting these reimbursements, a product of the recently ended legislative session.
The problem is dire, and the opportunities are great, said panelist Ely Sanders-Wilcox with the Oregon Department of Education.
“What a lot of us do is take it for granted that we have school nurses or somebody with medical knowledge in our schools,” he said. “We really don’t.”
Instead, non-medical professionals are being required to care for children whose needs they are not trained to understand – the result of a $100 million gap between the need for nurses, and the funds to pay for them, Sanders Wilcox said.
“We’re faced in Oregon with an ever-increasing need,” he said. “We are seeing more and more chronic disease management, more and more students presenting with complex medical concerns, and less and less nurses in the schools.”
State Rep. Julie Parrish, R- West Linn – who has drawn attention lately for backing an initiative effort to repeal recently passed healthcare taxes – said she supports the idea of boosting Medicaid funding in Oregon schools. She also wants to look for other ways to better integrate health and education systems, with students’ and parents’ needs in mind.
Before she ran for office, for several years Parrish routinely took one of her children out of school to a specialist for ongoing treatment – he missed school and she missed work as a result.
“Why aren’t we just doing this in school?” Parrish asked. “Can’t we just bill insurance and have this happen in the classroom? Think about all the parents who have to take sick days, or who don’t have sick days?”
Other comments from Parrish:
- “I’m hoping from a policymaker perspective this is the start of a dialog about how we tear down these walls”
- “Can we have – particularly for kids with disabilities – have a medically based education. What does that look like?”
- “What we are doing right now is absolutely not sustainable. We will go broke trying to deliver these types of services to kids”
Maureen Hinman, policy director of the Oregon School-Based Health Alliance, concurred with Parrish that many opportunities exist to bridge the education-healthcare gap.
“The opportunity that lies in providing healthcare in schools is immense. Just as education is a social determinant of health, so is health a social determinant of education, so to speak, and it is an equity issue, as well,” Hinman said.
Yet federal healthcare and education privacy rules create special challenges that can make it especially difficult to merge these worlds, she said.
Hinman delivered four recommendations for policymakers:
- Develop both local and state-level partnerships.
- Insure on-site access to health services in every school.
- Provide a healthy workforce environment – school personnel are also healthcare consumers.
- Develop shared metrics across health and education systems.
Sandra Clark, population health director at FamilyCare Health, emphasized the importance of digging into policy in order to boost funding for at-school healthcare.
“We all understand children in our own lives as whole people. Just because we walk into a clinic and are labeled a patient, or we go to school and are labeled a student, the funding streams create these unnecessary boundaries,” Clark said.
Those boundaries result in $40 million left on the table due to administrative burdens, she said – and it will take getting into the weeds of administrative rules and policy to solve this problem.
Dr. Lisa Bisgard, chief of pediatrics at Kaiser Permanente, said the effects of adverse childhood events on the rest of a person’s life make it especially important to attend to health needs at a young age.
“We have so many opportunities to collaborate as a health and education system to help these children grow up and become healthy adults,” she said. “The return on investment for children is a 15 to 20 year look.”
Speaking last among the panelists, Beaverton School Nurse Kim Bartholomew described an urgent situation.
Bartholemew works part time, serving three schools with total population of about 2,800 students. As neonatal intensive care programs have improved, the share of students with disabilities and related health problems has climbed – yet fewer nurses are serving schools than a generation ago, she said.
Today’s school districts find themselves caring for students in persistent vegetative states, with ostomy bag, with vagal nerve stimulators, with tracheostomies, catheters, in need of wound care and with a range of other complex medical situations. Nurses must attend to the most severe and complex, and delegate the rest, she said.