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School Health Centers in Danger of Closing, Budget Panel Hears

Posted on: Friday, 11 March 2005, 15:00 CST

Mar. 11--School-based health centers that provide care to poor children are in danger of closing due to the loss of federal and state money, an advocate told the House Finance Committee yesterday as it weighed the Health Department budget.

The committee also learned that cuts contained in President Bush's budget proposal along with a new federal mandate concerning school cafeterias threaten the state's ability to test the safety of beach water, inspect restaurants, prepare for a bioterrorist attack, and care for mothers and babies. About two-thirds of the state Health Department's money comes from the federal government.

Addressing the Finance Committee's subcommittee on health and advocates, Maria Montanaro, chief executive officer of Thundermist Health Center, of Woonsocket, which runs four school-based health centers, said the centers make a huge difference in the health of needy youngsters -- at a low cost to the state.

"I'd hate to see one of the best things we do go by the boards," Montanaro said.

Operating full-time in eight schools in poor communities (with a ninth scheduled to open), the centers provide such services as weight-management programs, smoking cessation, fitness initiatives, dental care, diabetes diagnosis and treatment, nutrition counseling, health education and psychological counseling.

Seven of the centers receive $75,000 each in state money. The budget proposal would reduce that to $41,000 -- too little for the health centers to survive, Montanaro said.

The school health centers are run by Thundermist, the Providence Community Health Center and the Blackstone Valley Community Health Center. Just under half their money comes from the state, Montanaro said. Roughly 20 percent is reimbursed by health insurers, and the rest is paid for by the three community health centers, from their operating budgets or federal grants.

The Health Department learned this year that $135,000 in federal matching funds from the Medicaid program could no longer be used for the school-based clinics. Dr. David R. Gifford, acting director, said the Health Department will tap $35,000 in tobacco-control money to help the clinics. He said the department intends to come up with the additional $100,000 for the current year.

But in fiscal year 2006, the health centers face the loss of nearly half their state assistance. The $135,000 from Medicaid will still be gone, and the governor's budget proposal cuts $108,632 of state money, leaving $281,368 to be split among the centers.

Montanaro said that her agency would have to close at least two of its four health centers if the cut is sustained.

Rep. Steven M. Costantino, D-Providence, Finance Committee chairman, said the school-based health centers should be collecting more money from health insurers, particularly for children covered by the state's RIte Care program. For RIte Care enrollees, the state is paying once to provide them with health insurance, and again to care for them in the health centers, he asserted.

But Montanaro said the health centers collect about all they can from insurers, including RIte Care. The state subsidy is needed because school health centers provide preventive and psychological services that are not covered by insurance. For example, Montanaro said, the staff typically spends an hour with each patient, much more than insurers will pay for.

"The best things we do in health care are for free," she said.

Gifford told the committee about several areas where the department was likely to lose crucial federal funding:

--Bioterrorism: The state will take a $1.3-million loss. The money is being diverted to metropolitan areas and regions that are not as prepared as Rhode Island, Gifford said.

--Maternal & Child Health Block Grant: The department is expecting the loss of $62,847 in federal money.

--Beach testing: The state is losing some $213,000 from the Environmental Protection Agency for testing the safety of the water at state beaches. Gifford said the Health Department may ask local communities or whoever runs the beaches to take over the testing.

--Food inspection: A new, unfunded federal mandate requires all 400 school cafeterias to be inspected twice a year. Currently the Health Department inspects 200 cafeterias once a year. Meeting the mandate will require diverting two food inspectors from such jobs as dairy, shellfish and restaurant inspections.

Costantino asked Gifford what the Health Department's reaction had been to the auditor general's report on the facilities regulation division. The report criticized the oversight of nursing homes.

Gifford called the report "insightful and helpful," and said the department has been looking at redirecting its workflow for greater effectiveness. For example, he said, the inspections are done with paper and pencil; Gifford wants to switch to a computerized system, similar to one recently adopted by food inspectors.

Costantino then asked whether such efficiencies could reduce the need for the six additional inspectors recommended in the governor's budget proposal. "Could you do it with three?" he asked.

"Less than six would be problematic," Gifford said, noting the auditor's report had said the request for six was too low.

In response to another question from Costantino, Gifford said his department is working with the Department of Human Services, which funds most of the nursing-home care, to set up systems for identifying nursing homes in financial distress.

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Source: Providence Journal

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