Why do students pay a fee at all?
Less than 15 percent of the Student Health & Wellbeing Services is University funded, so without health fees we could not maintain on-campus medical or counseling services. Student fee funding for health services is a CSU-wide practice. One semester’s health fees are less than a single visit to a health care provider off campus for uninsured students.

HSU already has one of the higher health fees in the CSU. Why isn’t that enough?
Unfortunately, HSU’s fixed costs are more expensive to students because we have lower enrollment than many other CSUs. There are also higher transportation and other costs due to location. Finally, other campuses provide fewer services and refer students to their local communities. The small community surrounding Humboldt State doesn’t have enough services available to meet the needs of HSU students.

Medical services are expensive -- one night in the hospital costs more than a semester of tuition, and we’re still able to keep our costs low enough to provide all of the services we do to students all semester with few out of pocket costs, all for less than the cost of a single cash visit to a health care provider off campus. For more details take a look at Understanding HSU’s Health Cost Factors.

Why not just charge students who use the facility?
All enrolled students (including those with health insurance or who think they will not need services) benefit from an array of Student Health & Wellness Services programs that go well beyond direct medical care.

Some students who consider themselves healthy or who anticipate using an off-campus health care provider often end up using the Student Health Center for reasons such as convenience, timely access, confidentiality, cost savings, limitations of insurance coverage, or to avoid insurance co-pays and deductibles. Others unexpectedly need urgent care or stabilization for medical emergencies, acute illnesses, injuries, or other medical needs.

All students receive the direct and indirect public health benefit of the Student Health & Wellness Services’ health promotion and public health efforts. These include protection from the untreated infectious diseases of others due to efforts to prevent, detect, and control diseases like TB, meningitis, influenza, measles, and mumps. There are also public safety benefits from accident and injury prevention efforts, as well as the availability of on-campus mental health services and psychiatric intervention.

In addition, all students benefit from Student Health & Wellness Services’ health issue advocacy and strategic planning at the campus-wide level, including disaster planning and preparedness.

What are the advantages of consultation? Was a referendum considered?
HSU has chosen an open consultation process, which seeks to gather campus opinions on health care and how health fee funding should be spent through open forums, a student survey, and comment submissions. Other CSUs have used this method to improve campus health services.The HSU Student Fee Advisory Committee, the student affairs team, and others believe using this process is the best way to maximize campus-wide engagement.

A referendum often makes the most sense when an increased fee supports an expense that is perceived as optional, but health and well-being services are a basic need on campus. The process for consultation will be highly proactive in reaching out to a broadly representative group of enrolled students, which is required by CSU policy.

Historically, student participation in AS elections has been disappointingly low, and a referendum may not ensure appropriate student awareness and feedback.

Having appropriate health and well-being support benefits all students. Insufficient health care or counseling services for students could place other students at risk, such as in cases of communicable illnesses or severe psychological issues. An, open consultation provides an opportunity to communicate the broader dimensions of this need.

How much data exists to support these conclusions?
Quite a bit actually - many students, faculty, staff, and administrators were involved in collecting and analyzing the relevant data to identify the need-capacity gap, the required fee adjustment, and the impact of increasing services to better support students. Those involved included members of the medical, counseling, and health education staff; Office of Institutional Effectiveness; Facilities; Central Budget Office; Student Affairs; President; President’s Cabinet; Student Financial Services office; Financial Aid; Student Health Fee Advisory Committee; and more. An external team led by economist Daniel Eisenberg, Ph.D. and the Healthy Minds Network team also conducted an assessment in 2017. Data collection efforts being led this semester by Connie Stewart and other members of the HSU California Center for Rural Policy will also be available online. For those interested in learning more please return to this site near the end of the semester for copies of the report on the open consultation process and visit https://wellbeing.humboldt.edu/data anytime for summaries of campus-wide health data and national benchmarking.


What is the Milliman Medical Index?
Student Health Fee has historically increased annually by the Higher Education Price Index (HEPI), however medical costs have outpaced higher education costs several years and will continue to do so make a medical cost index more accurate. The Milliman Medical Index (MMI) is an actuarial analysis of the projected total cost of healthcare. Milliman is among the world's largest providers of actuarial and related products and services. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. Unlike many other healthcare cost reports, the MMI measures the total cost of healthcare benefits, not just the employer’s share of the costs or premiums and only includes healthcare costs (e.g. not health plan administrative expenses or insurance company profit loads).


Can we just bill insurance to solve this?
CSU Executive Order 943 requires that a number of basic services be offered at no cost, without billing to insurance. This accounts for 95% of the currently offered services. Insurance billing is permitted for augmented services only, and not practical for HSU.

We currently offer a very limited number of these augmented services, and we charge students directly for the ones we do to balance costs and ensure the general population is not paying for highly specialized services used by only a select few. While it may be worthwhile to further investigate the possibility of Medical reimbursement for some of these services, we could not bill private insurance without adjusting the rates up for everyone. Our students also have a large range of insurances, meaning the number using augmented services who would qualify is small. In the end, we’re talking about such a small number of students using these augmented services, the amount of money recovered would not even cover the costs of an additional medical biller -- which is required to code idesm, bill, and track billings --  much less the additional training and documentation change models which would have a time impact on the entire staff. And, as we currently bill students directly, all of these would be additional costs to students.

In addition to the costs of billing and reconciliation that would require hiring at least one additional medical biller, and the need to contract separately with each insurance company, because of the obligation to collect deductibles and co-pays, the out of pocket cost to students would in most cases be higher than receiving student fee funded basic services. It would also require us to change practices in some case, and for the University to move Student Health Services to a HIPAA entity. Various CSU entities including the CSU SHC Directors, CSU VPs for Student Affairs & Chancellor’s Office and risk management staff reviewed this topic over the last few years, including the consultation with Keeling and Associates, and all have concluded that it was not worth pursuing overall insurance billing until CSU-wide policy changes. If the CSU system could become a Kaiser approved provider or offer a CSU-wide central medical billing department this might change, but at the moment it’s not possible for an individual institution to negotiation in this way.

The last critical issue to consider in billing insurance is access and social justice. Currently, about 1/3 of our students use Kaiser and another 1/3 are underinsured or uninsured. This could leave anywhere from 3000-6000 students unable to access services at the same level as other students. And, it will be the most vulnerable and underprivileged students who are most affected.