BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 1239 (Wolk) - School Nurses
Amended: April 21, 2014 Policy Vote: Education 6-1,
Health 6-1
Urgency: No Mandate: Yes
Hearing Date: May 12, 2014 Consultant: Jacqueline
Wong-Hernandez
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1239 requires school districts that are
eligible to receive concentration funding under the Local
Control Funding Formula (LCFF) to employ at least one school
nurse as a supervisor of health, as specified.
Fiscal Impact:
School nurses: Substantial reimbursable mandate, likely in
the high tens of millions of dollars, to require all school
districts eligible to receive LCFF concentration funding to
hire school nurses as supervisors of health, as specified.
Medi-Cal and insurance reimbursement: Likely minor local
cost savings, to the extent that this bill results in
additional billing to students' health insurance and/or
Medi-Cal, and that those insurance providers reimburse
school districts for eligible services actually rendered by
a school nurse.
Background: Existing law defines a school nurse as a registered
nurse (RN) currently licensed under the Nursing Practices Act,
and who has completed the additional educational requirements
for, and possesses a current credential in school nursing.
School nurses may perform, if authorized by a local governing
board, a number of services including, but not limited to,
conducting immunization programs, assessing and evaluating the
health and developmental status of pupils, and consulting with,
conducting in-service training for, and serving as a resource
person to teachers and administrators. (Education Code � 49426)
In 2013, the LCFF was enacted. The LCFF replaces almost all
sources of state funding, including most categorical programs,
and uses new methods to allocate these resources and future
allocations to school districts, charter schools, and county
offices of education. The LCFF allows local educational agencies
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(LEAs) much greater flexibility to spend the funds than under
the prior system. This formula is designed to provide districts
and charter schools with the bulk of their resources in
unrestricted funding to support the basic educational program
for all students, plus supplemental funding, based on the
enrollment of educationally disadvantaged students (low-income
students, ELs, and foster youth), provided to increase or
improve services to these high-needs students. County offices of
education (COEs) receive different funding levels within the
LCFF, based upon the same allocation principles.
The LCFF allocates resources to LEAs as follows:
1 Base Grants are provided to all school districts and
charter schools. They are calculated on a per-pupil basis
(measured by student average daily attendance) according to
grade span (K-3, 4-6, 7-8, and 9-12) with adjustments that
increase the base rates for grades K-3 (10.4% of base rate)
and grades 9-12 (2.6% of base rate).
2 Supplemental Grants provide an additional 20% in base
grant funding to school districts and charter schools for
each low-income student, EL, and foster youth (unduplicated
pupil count).
3 Concentration Grants provide an additional 50% above
base grant funding to school districts and charter schools
for each low-income student, EL, and foster youth that
exceeds 55% of total enrollment. (Charter schools are
capped at the concentration rate of the school district in
which they are located).
The LCFF includes new requirements for local planning and
accountability, including the creation of an LCAP for each
school district and charter school, which focus on improving
student outcomes in state educational priorities and ensuring
engagement of parents, students, teachers, school employees, and
the public in the local process. The LCAP must include locally
determined goals, actions, services, and expenditures of LCFF
funds for each school year in support of the state educational
priorities that are specified in statute, as well as any
additional local priorities.
Proposed Law: This bill requires school districts that are
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eligible to receive concentration funding under the LCFF to
employ at least one school nurse as a supervisor of health. This
bill provides that the supervisor of health shall supervise
other school nurses, RNs, or licensed vocational nurses employed
by the school district and, if applicable, a school nurse of a
county office of education, as specified. It also requires that
nurses hired supplement, and not supplant, existing employees of
the school district. This bill further provides that the
governing board of a school district may bill a pupil's health
insurer, or the Medi-Cal program for the cost of health care
services provided to the pupil, as specified.
Staff Comments: Approximately 510 school districts statewide are
eligible to receive LCFF concentration funding, based on 2012-13
enrollment data. This bill would require those 510 school
districts to employ at least one nurse as a supervisor of
health, to supervise other school nurses, RNs, etc. that might
be employed or contracted by the school district to provide
student health services; this bill requires the school district
governing board to consider specific factors in determining how
many additional nurses should be hired, to be supervised by the
supervisor of health. This bill also provides that the school
nurses hired pursuant to its provisions must supplement, and not
supplant existing district employees.
In other words, this bill mandates the hiring of a minimum of
510 new school nurses to serve in supervisory capacities. It
also creates substantial cost pressure to hire additional
nurses, based on the consideration criteria it requires, and the
implication that there would be other school nurses to
supervise. If it cost a school district $100,000 per supervisor
of health (this cost is likely low, when including health
benefits), the statewide cost would be at least $51 million per
year. The requirement for schools districts that are eligible to
receive concentration funding (which is determined by their
enrollment demographics) to hire additional nurses as health
supervisors would certainly be deemed to be a reimbursable state
mandate by the Commission on State Mandates.
This bill provides that the governing board of a school district
may bill a pupil's health insurer, or the Medi-Cal program, or
both, for the cost of health care services provided to the
pupil. This permissive provision is declaratory of existing law,
with regard to Medi-Cal, and nothing in state law prohibits
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school districts from billing private insurers. School districts
often bill Medi-Cal for medical services required in the
individual education plan (IEP) of a student receiving special
education-related medical services at school. The extent to
which this bill would result in school nurses providing
additional services to pupils that result in actual
reimbursement is unclear.
To the extent that additional services are provided and paid for
by Medi-Cal and private insurance companies, through
reimbursements, additional revenue may flow to local school
districts. This revenue will not, however, mitigate the costs of
the reimbursable state mandate because the action of billing is
permissive, is already allowed, and would occur outside of the
state mandate to hire health supervisors.