Medicaid agency helping school clinics succeed

COLUMBIA, S.C. (AP) — Four high-poverty schools in Charleston County could become a statewide model for in-school medical clinics that offer parents a convenient way to take their children to the doctor’s office.

South Carolina’s Medicaid agency is working with a nonprofit, Charleston Promise Neighborhood, to expand services in the KidsWell clinics it first opened in 2011 with grant money and one pediatrician volunteering two hours weekly at each school. Agency officials say they want to simultaneously help the clinics grow and become financially stable, so services don’t depend on fluctuating grants. That involves helping enroll qualifying students in the government health care program for the poor and disabled, as well as training staff on how to bill Medicaid for services.

“We’re trying to make sure they’re using every possible opportunity” for reimbursements, said Melanie Giese, a deputy director of the Department of Health and Human Services.

If students can be treated at school, they’re less likely to end up in emergency rooms, where treatment is much costlier to the state, she said.

It also means they are more likely to stay in class and able to concentrate while there, said Sherrie Snipes-Williams, chief executive officer of Charleston Promise Neighborhood.

“We wanted to ensure students are healthy and able to learn, and that a majority of the time they’re in class and not out sick,” she said about why the nonprofit launched the program as part of its larger goal of transforming the community. “It also allows parents to be able to stay at work and not take off and miss time to deal with minor health care challenges.”

The poverty ratings of Chicora, James Simons, Mary Ford and Sanders-Clyde elementary schools are just shy of 100 percent. That means nearly every child qualifies for Medicaid. Yet, across the four, just 62 percent of their 1,700 students are covered by the health care program.

Officials expect that number to rise in the coming weeks, as Medicaid and school officials work together to help parents sign their children up.

Last school year, 300 students logged more than 530 visits to the clinics. Those numbers could easily top 600 students making 1,600 visits this year, thanks also to a more formal partnership with the Medical University of South Carolina, Snipes-Williams said.

Beyond allowing time for the doctor to volunteer, MUSC is hiring a full-time nurse practitioner for the schools, whose salary will be partly paid by a $50,000 grant from Blue Cross Blue Shield. It’s also adding a telemedicine component, allowing the advanced-practice nurse to “see” children no matter where she’s based that day, as well as consult with specialists via monitor.

“If our nurse practitioner is in one school and a child is sick in another, she’ll connect,” said Dr. James McElligott, director of MUSC’s telehealth program.

Beginning Sept. 16, each of the school’s clinics will open one full day weekly and share Fridays, giving students 40 hours of access to health care at school, instead of two. Visits can be by appointment or a walk-in referral from a teacher, provided a parent has signed a waiver, which are being collected now.

Parents already have stacked up appointments for opening day, said Anthony Dixon, principal of Sanders-Clyde, whose students include residents of a nearby homeless shelter.

Common visits have included hearing and vision screenings, physicals, and asthma treatments — things that may sound minor but make a big difference in students’ health and education. The clinic has also helped by educating parents on their children’s health, he said.

“Parents are becoming more aware of the connection between school work and being present,” he said. “The attendance rate has stabilized.”

McElligott, also an assistant professor of pediatrics at MUSC, likened school clinics to the house calls that family doctors once made.

Nationwide, the concept has exploded over the last five to 10 years. In that respect, South Carolina is trailing, but the partnership with Medicaid could make the state a leader, McElligott said. In other states where school clinics depended on grants or fluctuating allotments from the state budget, many had to cut back or close, he said.

“For Medicaid to come to the table and say, ‘We want to make this work for you,’ is a blessing. We’re really excited,” he said. “We want to cut through the red tape and barriers to (Medicaid) reimbursement.”

South Carolina’s Republican leaders have repeatedly rejected Democrats’ efforts to expand who’s eligible for Medicaid, as encouraged in the federal health care overhaul. Medicaid Director Tony Keck has repeatedly argued that South Carolina first needs to focus on improving residents’ health while lowering costs in a state that ranks among the most unhealthy nationwide. Currently, nearly 1 million residents are covered by the health care program.

Medicaid’s partnership with the four schools in Charleston and North Charleston, following Keck’s visit several months ago, is part of his agency’s efforts to improve health by making access to health care more convenient. The agency hopes to expand the pilot after “fully developing A through Z how this model can be sustainable,” Giese said.

That might start with schools already offering some form of in-school health clinic. McElligott was tasked this summer with trying to coordinate with and expand on programs across schools in Beaufort, Charleston, Chester, Florence, Jasper and Williamsburg counties, which are in various stages.

“The hope is that we can bring all of these programs together in an alliance and work more effectively with Medicaid,” McElligott said. “This is just the beginning.”

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