Student Health Services in the California Community Colleges were first authorized in 1963 when the ability to collect a student health fee was tied to legislation authorizing the collection of parking fees.  It has been downhill since then.

Although health is well documented as a necessary attribute of a successful college student, and despite the fact that our students often represent the demographic most likely to be without regular access to health care or the resources to pay for it when needed, the California Community College system has never mandated the provision of Health Services. Permissive legislation allowed the establishment of a health fee. Waivers of health fees for low-income students have impacted the viability of our programs; as Financial Aid outreach is successful, and the cost of enrollment increases, more and more health fee dollars are lost to the health services coffers. 

Every California college student deserves a college-based health service.  Without access to health care, students are more likely to drop classes, fail classes, or leave our campuses altogether.  A study by the University of California system cited health as the reason 25% of students dropped classes. The California State College system and the University of California system enjoy the benefits of stable and broad based health centers.  In this era of declining community health resources, terrorism, emerging infections and campus violence, every Community College needs the same services.  It is time for the California Community College system to meet that obligation.

Factors affecting the SHS Budget

Health Services are generally supported by the health fee and/or specific activities related to health services, i.e. grants, MAA billing, mandated cost reimbursement.  By statute, excess health fees are kept in a separate health service reserve for lean years.  Health fees are set by law at a minimal $13 per semester, $10 per quarter, with a rise in fees tied to a retroactive state-wide cost indicator not related to the CCC budgeting process or real costs associated with health care.  Any low-income student who receives a BOG waiver for enrollment fees also has his/her health fee waived.  There is no reimbursement from the state to the college health service for these waived fees.  The Health Services Association, California Community Colleges (HSACCC), is the organization representing health services on our campuses.  This organization is currently advocating for the elimination of this waiver as counterproductive to the interests of our students and our organizational mission of promoting successful students.  In recent weeks, legislation removing this mandatory waiver from the Education code has been introduced (AB982-Laird) and will be making its way through the legislative process.

Title 5 mandates certain services may be provided if a college is collecting a health fee.  If the cost of providing the range of services that was provided in 86-87 grows beyond the revenue collected for the program, the college is allowed to make a claim to the State for reimbursement for the cost of these mandated services. In 2002 the repayment of mandated claims was put on hold.  The estimate is that annually, SHS in the California Community Colleges generate about $16 Million in unfunded mandated service claims. We are not allowed to use this money for budgeting purposes, and the reality of collecting it is probably many years away.  Currently, the state controller is auditing most of the colleges’ claims in an aggressive attempt to make these receivables disappear.

Other factors affecting Health Services’ ability to reach a balanced budget include:

• Increase in Financial Aid outreach results in more “waived” students
• Increase in enrollment fee qualifies more students for waivers, and students who may have been qualified before but chose not to apply may do so now that it is more expensive.
• Any decline in enrollment affects us directly as well as the entire college.

Recently, this funding scenario has resulted in a ‘perfect storm’ for many of our community college health center budgets.  Shrinking revenues related to the above factors, combined with accelerating costs, have led to layoffs in both faculty and classified staff and reductions in hours and services.  Increases in Health and Welfare benefits, PERS contributions, Workman's Compensation costs, and negotiated basic salary increases have all contributed to the basic mismatch in funding and expenses in our area.  Increasing student liability insurance premiums, which are paid by health fees at many colleges, are also adding to the crisis.

Previous Efforts to Address this Funding Inequity

Numerous efforts have been undertaken to provide reasonable, predictable funding for the Health Services on our campuses.  The Chancellor’s Office staff has filed at least five Budget Change Proposals since 1995, suggesting many options for this relief. Alternatives have included a flat amount per student from the general fund to augment any health fees collected from the students, backfill of the waived fees from the general fund budget, limiting waiver of fees to only BOG A and B students, and eliminating the BOG waiver of health fees altogether. 

Legislation (AB549) was written in the 1995 FY to allow CCC Health Centers to bill MediCal.  Unfortunately this option that has not provided relief due to an inability of the Department of Health Services to produce a contract, and the low percentage of community college students eligible for MediCal.  The implications of having to establish MediCal billing for many of our health centers are overwhelming as well, requiring billing systems, computerization, and trained staff.  For health centers operating with crews that are already shrinking, this is not a viable alternative.

The Health Services Association (HSACCC) has lobbied consistently and diligently to mitigate our funding problem.  Position papers have been written, presentations made to the CSSO organization, the BOG, the Community College League, FACCC, Faculty Senate, Legislators, and many boards of Trustees.  Last year, again, working in concert with the CSSO Association, a Budget Change Proposal to backfill the BOG waiver was included in the system budget.  This year after significant effort, consensus building, endorsement by all members of the Consultation Council and adoption by the Board of Governors, this line item was included again.  Once again, it was not funded.

Next Steps for Student Health Services

Working in concert with the various constituency groups, and with the endorsement of the Student Services Council, the Association is working to have the Health Fee unbundled from the BOG waiver, and to be paid by all students in the future.  To continue removing low-income students’ fees from the revenue stream threatens those students most in need of our services.  To rely on a vulnerable line item backfill from year to year creates uncertainty, inconsistency in services, and inequity for our students. This legislative change is not without risks to the little stability afforded by the current fee structure.  By opening the Ed Code to changes, untoward results may occur without close attention to the legislative process.  HSACCC has set a goal for 2004-2005 of identifying legislative support for carrying this legislation, and working toward the revamping of our funding dilemma.

On a parallel path, it is the intention of the Health Services Association to continue to press for a backfill of the BOG waiver for the coming Budget Year.  While we are not optimistic about this second approach, the momentum for this change and inclusion as a line item will continue to be pursued.  Failing this year, we will continue to press for a similar backfill line item next year. We also will continue to press for funding of the Maintenance of Effort mandate.

In summary, the California Community College system holds the potential of providing an essential student service for all its’ enrollees.  Campus based health services provide cost-effective, culturally appropriate, accessible services that are essential for our students’ success.  Our students deserve no less, and our colleges require no less, than our counterparts in the CSU and UC systems. Funding for this resource has been marginal to perilous for many years and appears to be on the brink of extinction in many colleges. Without attention to adequate, reliable, funding this resource is in danger of disappearing from many of our campuses.  The time has come to work towards a realistic, long term funding strategy that leaves these services, and our students and campuses, less vulnerable.