For some Bell County kids the only healthcare they get comes from their school nurse, but 11 school health clinics could shut down by the end of this school year.
That's because in November 2011, Kentucky switched from a traditional Medicaid program to using Managed Care Organizations, which have been slow to reimburse clinic operating costs.
Kentucky contracts with three MCOs to manage most Medicaid patients: Kentucky Spirit, Coventry Cares, and Wellcare.
The goal was to save taxpayers money, and it may have worked a little too well.
The Bell County Health Department says they aren't being fully reimbursed for the costs of operating their school clinics.
Eight-thousand children have access to a school nurse every year, thanks to their program.
Registered Nurse Johnna Callebs saw more than 20 students before 2 p.m. on Monday.
"You get so attached to these kids, you just love these kids," says Callebs who has worked at the Bell County middle and elementary school for 19 years.
There's the frequent visitors to her office who come in for hugs or words of encouragement. And then there those 'special needs' children who need daily medications or to be monitored for seizure disorders.
"We have a lot of kids with special needs that won't be seen maybe by anyone if we're not here," says Callebs.
With only two local physicians performing routine immunizations, Interim Public Health Director Judy LeFevers says their school clinics vaccinate 90% of Bell County School District children.
They also offer preventive care, like blood pressure, eye, and vision testing. Students can also access nutritionists.
"It's really a mini-health department," says LeFevers.
In previous years, Medicaid covered 70% of the clinic's costs. The health department funded the remaining 30%.
But now LeFevers says the 70% that should come from the MCOs is trickling in, or not coming at all.
They're currently waiting on hundreds of thousands of dollars in reimbursements. One company says LeFevers, owed them more than $250,000 but so far has only paid $12,000.
"If the MCO's don't come around, we're not going to be able to recoup the Medicaid money," says LeFevers. "I hate to say it but I see school clinics in Bell County [becoming] nonexistent."
So far, more than 2,000 people have signed a petition asking elected officials for help.
State Rep. Rick Nelson is listening.
Nelson says the problem extends far beyond schools. There are also local hospitals being forced to borrow money just to make payroll
In response, he proposed House Bill 42. The bill states that if an MCO breeches their contract with the state, hospitals and clinics should be able to cut ties.
Then he says, they could go back to billing Medicaid.
The bill is pending before the House Health and Welfare Committee.
Nelson says he also plans to propose another bill exclusively dealing with school health clinics this week.