School-based health centers await contracts and expansion funds but push forward

While operators of school-based health centers are voicing concern about a delay from the state in getting both contracts and funds for expansion of services, they are assuring people that clinics providing health care to students will be open when school starts.Child and Family Agency of Southeastern Connecticut operates these kind of primary care clinics at schools in Groton, New London, Stonington and Waterford, and CEO Allison Blake said the centers will open even though contract renewals haven't come through.The agency is also going to be offering mental health services at new centers this fall. Blake said the plan is to eventually also offer physical health and behavioral health services, but the agency is waiting for the state to sort out what's happening with additional funding.The new centers will be at Harbor Elementary School in New London, and Charles Barnum and Northeast Academy in Groton.Child and Family Agency receives grants from the Connecticut Department of Public Health for its school-based health centers, and centers can bill for services through Medicaid or private insurance. But without a contract with DPH, how is the agency funding the centers?"We have some unrestricted dollars available through the generosity of our donors, and so we will use those funds to carry us until the contract renewal comes through," Blake said, "And then of course, we'll bill for services as we normally would, so we'll make it work."Blake has confidence that DPH is working on the contract renewals and she doesn't envision getting to a place where Child and Family Agency would have to suspend services, but she is concerned that funds set aside to support children and youth haven't been distributed.She's seen heightened mental health needs among children as a result of the social and emotional isolation experienced during lockdown, and the agency has had increased requests for service. She called school-based health centers "a critical part of the safety net for children and youth in our communities." As Blake awaits contract renewals, she's trying to make decisions on hiring, a process that takes longer than it did before the pandemic."The staff inside DPH are our partners, and they're folks that we work with and my staff work with every day, and we recognize that they are short-staffed as well," Blake said. "I think we're all just trying to understand what the plan is and what the time is for the distribution of funds, or a competitive bidding process if that's the plan. We're not looking to be negative."Child and Family Agency is one of multiple nonprofits involved in the Community Foundation of Eastern Connecticut's ARPA (American Rescue Plan Act) Steering Committee, which sent a letter on July 29 to DPH Commissioner Dr. Manisha Juthani, asking about both the status of $22 million in funds and about a holdup in approving SBHC contracts."We are concerned about the delay in releasing critical federal and state funds intended to support the expansion of existing school-based health services and the implementation of new services in schools and school districts that have been identified as needing those resources to support the children and families of their communities," the committee wrote.They said their understanding is that site contracts renewable July 1, 2022 "are held up with a language dispute in the Attorney General's Office" and that two pots of funding, for $10 million and $12 million, are also awaiting approval by the AG's office. Attorney General William Tong was also copied on the letter."There is no dispute with the Attorney General," spokesperson Elizabeth Benton said in an email Wednesday. "We reviewed the contract and sent it over to DPH on August 1. We defer to DPH for comment."Community Foundation President and CEO Maryam Elahi said she hasn't gotten a response to the letter from DPH.DPH spokesperson Chris Boyle said in an email to The Day on Thursday, "DPH is working as diligently as possible to complete their work, including approving contracts and dispersing funds in order to ensure we are serving our residents as effectively as possible."Awaiting expansion fundsSchool-based health centers are primary care facilities licensed as outpatient clinics or hospital satellites, the Connecticut Association of School Based Health Centers explains, and parents must sign a permission form for students to receive services.Association Executive Director Melanie Wilde-Lane noted that providers bill insurance for those who have it but don't bill for co-pays or deductibles, meaning there is no out-of-pocket cost to families for SBHC services.She said the previous three-year contract expired at the end of last school year, and the state is working on a five-year contract with some language changes that had to go through legal counsel."I know everybody's quick to blame the Department of Public Health for not getting the contracts out, but I will say that they are working tirelessly," Wilde-Lane said, "and any time there's even a simple word change, it goes through this huge process."As for the additional funding, Wilde-Lane said DPH is figuring out how to distribute $12 million in federal COVID-19 relief dollars and $10 million the state approved in Senate Bill 1, An Act Concerning Childhood Mental and Physical Health Services in Schools.Boyle explained that the $12 million is part of an award from the Centers for Disease Control and Prevention, and the CDC requires states to use at least 25% on school-based health programs. He said a request for proposals will go out for these funds.The other $10 million is part of Senate Bill 1, which all Democrats and most Republicans in the Connecticut General Assembly voted in favor of this spring. Gov. Ned Lamont signed the bill May 24.Among other things, it requires DPH to administer a grant program for the current fiscal year for the expansion of school-based health centers and their services. Eligibility is based on the final report of the School-Based Health Center Working Group, which recommended 36 sites for expanded mental health services and 124 schools for expanded medical and mental health services.The operators of any of these sites are eligible for a grant, and DPH will give priority to operators that will provide services after regular school hours.Wilde-Lane said she knows school-based health centers "are really anxious" that the funding and the contracts haven't come through and they're not hearing a lot about it, but her association is talking to people at DPH and passing information along. She said DPH, like other state departments, has been affected by a lot of retirements.The contract issue with DPH doesn't apply to all providers of school-based health services, because many don't get funding from DPH.United Community & Family Services is self-funded through insurance reimbursement and doesn't have contracts with DPH, Chief Operating Officer Cara Westcott said, so the contract holdup doesn't apply.UCFS operates school-based health centers in Norwich, Waterford and Montville. Westcott said they will open on time but there won't be any funds to support an expansion.She said one thought UCFS had for expansion is adding primary care services to Teachers' Memorial Global Studies Magnet Middle School and Stanton Elementary in Norwich, which currently only provide behavioral health services.Westcott said it would be faster to add services to existing sites. But only half of the eight centers UCFS implemented since 2014 had existing locations, "so we're kind of versed with building it from the ground up and working with the school and trying to figure out where the best place would be."Community Health Center Inc. operates more than half of the school-based health clinics in the state but only 17 of more than 180 in total get funding from DPH, Hearst Connecticut Media reported. In southeastern Connecticut, CHC runs the school-based health centers at Marine Science Magnet High School in Groton and ISAAC in New London, according to Ledge Light Health District.e.moser@theday.com