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F I S C A L I M P A C T R E P O R T
SPONSOR Begaye
DATE TYPED 2-11-05
HB 552
SHORT TITLE School-Based Health Clinic Support
SB
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 SB 761
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
House Bill 552 appropriates $2 million from the general fund to DOH for the purpose of support-
ing existing school-based health clinics statewide.
pg_0002
House Bill 552 -- 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.
pg_0003
House Bill 552 -- 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
House Bill 552 duplicates Senate Bill 761.
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