Financing School Health

Schools use a variety of funding resources to finance school health services including school nursing. The purpose of this information is to provide a broad overview, not an exhaustive explanation, of school health financing and links to resources for further information.

The Minnesota Department of Education (MDE): School Finance is responsible for administering the state’s pre-K through 12th grade financing system. This includes federal, state, and categorized funding streams i.e., general education and special education. Decisions about funding school health staff, services, and supplies is mainly determined at the local school district level. School nurses should work with district leadership to understand funding at the local level.

Time and Effort

School nursing services are often supported by both general and special education budgets. MDE requires time and effort documentation for all staff support through two different funding sources. Daily documentation must reflect the actual activities spent providing services in each funding source. School nurses should contact the Special Education Director in their district to determine if this requirement applies and how Time and Effort is documented.

Third Party Reimbursement in Education

Federal and state law (MN125A.21 Subd. 2 Third Party Reimbursement) requires all public Minnesota schools to request payment for individualized education program (IEP) or Individualized Family Service Plan (IFSP) health-related services from public and private health insurers. Minnesota Health Care Programs (MHCP) pays the federal share of covered health-related services described on a child’s IEP or IFSP.

Third party Medicaid billing helps to access funds to support Minnesota schools in building capacity to provide better health and behavioral health services to students. School nurses should work with their Special Education Director and/or Third Party Billing Administrator to learn more about their participation in their district. More information is found at MDE Medicaid in Education or for information on upcoming trainings, recordings, insurance denials and other billing related materials, request an invitation from MDE to access the third party reimbursement (TPR) SharePoint site.

Non-public School Health Services

Non-public health services fund health services to students enrolled in private, parochial, or home schools. To participate in the Health Services Program, students must be enrolled in grades kindergarten through twelfth grade in a participating non-public school.

The Nonpublic Pupil Aids are intended to reimburse local public school districts for costs incurred in the direct provision of health services to nonpublic students. Public School Districts are charged with providing the services which means all services must be provided by qualified staff employed by or under contract with the public school districts. Districts are expected to provide the same specific services to the nonpublic students as are provided to the public students within the district, without exceeding the reimbursement rate. Since the reimbursement rate is a statewide average, low spending districts may be able to provide equal services without spending the entire maximum reimbursement. In these cases, once the district has reached the equal treatment threshold they are expected to stop, as going beyond this point would mean equal treatment is no longer being met.

The funds cover salaries, benefits, travel, and supplies used by the health professional. Only supplies brought to the site by the district health professional for usage in the fields of physical or mental health are eligible for reimbursement. These supplies are not to be used by nonpublic school staff and the program does not purchase supplies for nonpublic schools. Nonpublic schools are expected to purchase their own medical supplies which would be available for the nonpublic school staff to use when the visiting public school health professional is not at the nonpublic school.

This is a public school program designed to service nonpublic students and the public school makes the staffing and spending decisions. Nonpublic schools do not have the authority to spend the money generated by this program. The Nonpublic Pupils Aids program is not intended to be comprehensive and is designed to supplement a nonpublic school's own efforts to meet the health needs of their students.

Home school students are considered non-public students and may access health services through the local public education district.

More information can be found at MDE Nonpublic and Homeschool and MDE School Finance: Non-public. The associated legislation is MN Statute 123B.44 Provision of Pupil Support Services

Early Childhood Screening

Early Childhood Screening (ECS) is a state authorized and state funded program to Public Schools. School nurses have an essential role in the program. School nurses should consult with their district leadership. More information about ECS and funding can be found at MDE Early Childhood Screening.

School Based Public Health Nursing Clinics

Through the MN Department of Human Services (DHS), Minnesota Health Care Program (MHCP), some school nursing services may be reimbursed to students who are covered through a MHCP.

School-based public health nursing clinics must meet the same requirements as a Public Health Nurse Clinic. They must be a department of, or operate under the direct authority of a unit of government. Examples of a unit of government include county, city, or school district.

For more information on how schools can enroll as provider, covered and noncovered nursing services, and billing requirements can be found at the MN DHS, School Based PHNC.

Interagency Relationships/Contracts

School health services may be provided through interagency agreements and/or contracts with a local, private, or public agency. The contract arrangement should describe the services to be provided as well as the source and method of payment. In these instances, the cost of providing services can be financed from a variety of sources depending on the services provided.

Local Voluntary and Service Organizations

Local voluntary and service organizations can be solicited to provide funding for specific school health services budget items. For example, a local service club may purchase an audiometer or blood glucose meter for school health services and student use. Examples of service organizations include Lions Clubs, Kiwanis Clubs, Masons, Rotary, and others. Each service organization has local service programs that they support both with money and time.

Grants

Public and private grants may be a good source of money to start new programs. School districts may receive funding for various school health programs by applying for money granted by the federal, state, or local governments, private foundations, and nonprofit organizations. While application for these grants may take considerable staff time, it is sometimes an innovative way to fund programs or services not endorsed by other sources.