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F I S C A L I M P A C T R E P O R T

SPONSOR Pinto

DATE TYPED 2-11-05

HB

SHORT TITLE School-Based Health Clinics

SB 761

ANALYST Collard

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$2,000.0

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

REVENUE

Estimated Revenue

Subsequent

Years Impact

Recurring

or Non-Rec

Fund

Affected

FY05

FY06

$600.0

Federal

(Medicaid)

(Parenthesis ( ) Indicate Revenue Decreases)

Duplicates HB 552

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Public Education Department (PED)

Commission on Higher Education (CHE)

Department of Finance and Administration (DFA)

SUMMARY

Synopsis of Bill

Senate Bill 761 appropriates $2 million from the general fund to DOH for the purpose of sup-

porting existing school-based health clinics statewide.

Senate Bill 761 -- Page 2

Significant Issues

DOH states the National Assembly on School-Based Health Care estimates for school-based

health centers (SBHC) funding ranges from $150 thousand to $200 thousand per year for opera-

tional expenses while state funding in New Mexico for SBHCs is $20 thousand to $50 thousand

per year.

PED notes more than one-fifth of New Mexico’s children have no health insurance. New Mex-

ico has the nation’s highest rate of uninsured children. PED indicates half of SBHCs serve urban

communities, half serve rural communities and half serve only high school students. The SBHCs

provide an accessible location in schools where students can receive a wide variety of medical

and behavioral health and prevention care services. SBHCs provide trained, licensed profes-

sional health care providers. PED notes, through SBHCs, students learn how to use medical ser-

vices in a non-threatening environment, with referrals made to appropriate community providers.

They do not to miss school to receive health care.

DFA notes each SBHCs offers three different levels of service. Level one (basic) provides a

minimum of four hours of primary care and four hours of behavioral health services per week.

Level two provides a minimum of sixteen hours of primary care and sixteen hours of behavioral

health services per week. Level three (comprehensive) provides a minimum of forty hours each

of primary and behavioral health care. Of the 34 exiting SBHCs, 15 centers provide level one

care, seven provide level two care and two provide level three care.

Most of the visits students make to SBHCs are for primary care. About one quarter of the visits

are for family planning or sexually transmitted diseases. Another 15 percent to 20 percent are

for mental health services. Most of the students who visit a SBHC might not receive health care

services otherwise.

FISCAL IMPLICATIONS

The appropriation of $2 million contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to the gen-

eral fund.

DOH notes the Human Services Department (HSD) would be able to draw down federal Medi-

caid matching funds based on the percentage of Medicaid-eligible children served by the existing

SBHCs. It is estimated that the federal match would be approximately $600 thousand (based on

a 30 percent Medicaid-eligibility rate). HSD would require that DOH use these funds to improve

and expand SBHC staffing and support.

DFA notes existing sites currently operate on a combined annual budget of $500 thousand from

the general fund. Some of the existing sites receive federal or foundation support from other

sources. An additional $2 million could potentially elevate all 34 existing sites to level three fa-

cilities. According to DOH analysis, $1 million will elevate each exiting site by one level. For

instance, $75 thousand for the SBHC at Taos High School would add one mental health provider

and one clinic coordinator who can cover Medicaid billing. These added services would change

the currently level of the Taos SBHC from level one to level two.

Senate Bill 761 -- Page 3

The executive recommendation includes $3 million to PED for support of new school-based

health clinics.

ADMINISTRATIVE IMPLICATIONS

DOH indicates a joint powers agreement would need to exist between DOH and HSD. DOH

would be charged with the procurement process, contract monitoring, program oversight and

providing technical assistance to the funded SBHCs. HSD would be responsible for obtaining

federal Medicaid match and to ensure compliance with Medicaid requirements.

DUPLICATION

Senate Bill 761 duplicates House Bill 552.

TECHNICAL ISSUES

CHE suggests the bill be clarified to state whether these school-based health clinics are K-12 or

whether or not this appropriation would include health clinics at the state funded higher educa-

tion institutions.

OTHER SUBSTANTIVE ISSUES

DOH notes SBHCs provide a mechanism for the delivery of needed health services to school-

aged children and become the focus for tackling some of the health challenges faced by New

Mexicans: teen pregnancy, youth suicide, obesity, substance abuse. They are a proven interven-

tion to improve preventive care for the adolescent population who do not normally seek care in

the community health care system. SBHCs emphasize early detection, prevention of physical

and mental health problems, and reduce the inappropriate use of emergency room services.

KBC/njw