Health / Medicine Archives

What we’re watching next week in Missouri Legislature: budget, oversight hearings and MLB antitrust exemption pushback

April 17, 2021 By Brian Hauswirth

The proposed state operating budget will be heading to the Missouri Senate Appropriations Committee in Jefferson City next week for daily hearings and for consideration. The state Constitution requires lawmakers to approve a balanced budget by early May.

House Budget Committee Chairman Cody Smith (R-Carthage) and State Rep. Brad Hudson (R-Cape Fair) have a discussion on the Missouri House floor on April 1, 2021 (file photo courtesy of Tim Bommel at House Communications)

The Missouri House approved a $34.1 billion state operating budget this month, a budget which does not contain funding for Medicaid expansion. It includes a $76 million increase for foster and adoptive children, including a 45 percent increase to the clothing allowance for foster teens.

Kids Win Missouri policy director Craig Stevenson says the House budget provides unprecedented support for the kinship and foster families who care for the thousands of children in Missouri foster care. The state Department of Social Services (DSS) notes there are currently
13,939 foster care children in Missouri.

“It increases everything from the maintenance, the monthly maintenance payments that foster guardian and adoptive parents get. But then also increases important things like the diaper allowance for people who are caring for infants,” Stevenson told Missourinet this month.

House Budget Committee Chairman Cody Smith (R-Carthage) tells Missourinet that he will not be testifying before the Senate Appropriations Committee next week. He says Committee Chairman State Sen. Dan Hegeman (R-Cosby) will be the Senate handler.

The House has also approved a budget blueprint from Chairman Smith that directs dollars slated for Medicaid expansion for other programs. Smith says it’s a $342 million bill. That includes $88 million for long-term care in nursing facilities, $15.5 million for k-12 school transportation, $2 million for adult high schools, $11.6 million for the Department of Mental Health (DMH) for alcohol and drug abuse treatment, $53 million to DMH for adult community programs and $30 million for programs like respite care, adult day care and home-delivered meals.

House Special Committee on Government Oversight Chair Rep. Jered Taylor (R-Nixa) speaks on the Missouri House floor in April 2021 (file photo courtesy of Tim Bommel at House Communications)

Democrats in the Missouri Senate are expected to try to restore funding for Medicaid expansion, which was approved by 53 percent of Missouri voters in August.

The issue of oversight will also get more attention next week in the Missouri House.

The House Special Committee on Government Oversight plans Monday and Tuesday hearings about operations within the Department of Social Services (DSS) and the state Department of Labor and Industrial Relations (DOLIR). The issues at faith-based boarding schools like the now-defunct Circle of Hope will likely be discussed again.

Prescription drug monitoring program (PDMP) legislation will be heard by the Missouri House Veterans Committee on Tuesday afternoon. The committee will hear testimony from bill sponsor State Sen. Holly Rehder (R-Scott City). The Senate has given final approval to PDMP, which is an electronic database that collects data on controlled substance prescriptions within a state. Missouri is the only state in the nation without a PDMP.

Senate President Pro Tem Dave Schatz (R-Sullivan) supports PDMP, saying it provides a layer of protection against drug and dependency and dangerous drug interactions.

Meantime, the Missouri Senate Rules, Joint Rules, Resolutions and Ethics Committee meets Tuesday to hear testimony from State Sen. Rick Brattin (R-Harrisonville) about his resolution, which urges Congress to end Major League Baseball’s (MLB) federal antitrust exemption. Senator Brattin’s resolution is in response to MLB’s decision to move the All-Star game from Atlanta because of Georgia legislation requiring photo ID.

“This is yet another instance of corporate virtue signaling and sports stoking the culture wars in this country,” Brattin said last week. He also says MLB is undercutting the basis of its antitrust exemption. He notes the exemption has been in place since a 1922 U.S. Supreme Court decision.

Critics of the Georgia law say it will make it more difficult for minorities and the elderly to vote.

Missouri’s gasoline tax will also be discussed this week. The Missouri House Transportation Committee meets Wednesday afternoon at 5 to hear testimony from Pro Tem Schatz (R-Sullivan) about his bill, which increases the state’s gasoline tax by 2.5 cents each year, for a total of a 12.5 cent per gallon increase by 2025. The GOP-controlled Missouri Senate has already given final approval to the bill.

Missouri’s 17-cent per gallon gasoline tax has remained the same since 1996.

Missouri House Oversight Committee chair announces DOLIR is suspending collection of unemployment overpayments (AUDIO)

April 16, 2021 By Brian Hauswirth

Just two days after being grilled again by state lawmakers in both parties, the Missouri Department of Labor and Industrial Relations (DOLIR) is suspending all collection of unemployment overpayments, at this time.

Missouri House Special Committee on Government Oversight Chair Rep. Jered Taylor (R-Nixa) speaks on the House floor on March 4, 2021 (file photo courtesy of Tim Bommel at House Communications)

Missouri House Special Committee on Government Oversight Chairman State Rep. Jered Taylor (R-Nixa) made the announcement on the House floor Thursday in Jefferson City, to bipartisan applause.

“So I just want to let the members (state representatives) know that all collection efforts for all Missourians, 46,000 people who are having overpayment collection efforts being taken on them right now, are all on pause and again that’s due to the work that our (oversight) committee did so thank you, Mr. Speaker,” Chairman Taylor says.

DOLIR has posted a short message on its website, which confirms what Chairman Taylor said on the floor.

DOLIR has testified that the state overpaid more than $150 million in unemployment benefits last year and that 46,000 Missourians have been impacted by the unemployment overpayments.

Taylor says collections are being suspended “until we get the work done in this body.”

“And it’s due to the good work of the Government Oversight Committee, so I just wanted to thank the members for holding the Department (of Labor) accountable and holding them to what they agreed to to our body,” says Taylor.

State Rep. Raychel Proudie (D-Ferguson), the oversight committee’s ranking Democrat, has raised the same concerns that Taylor has.

The issue has been the subject of several bipartisan hearings by the Oversight Committee, which also learned about the COVID pandemic’s massive impact on Missouri’s economy and on the unemployment system.

DOLIR Director Anna Hui testified in February that Missouri paid out $236 million in unemployment benefits in 2019. That number increased to $5.1 billion in 2020, due to the pandemic.

During that February hearing, lawmakers in both parties said that Missourians who didn’t commit fraud should not have to repay money, because the state made the error.

State Rep. Richard Brown (D-Kansas City), the assistant minority floor leader, told Director Hui that a woman he knows received a letter in January, asking her to repay $23,000. Representative Brown has said the woman doesn’t have the money.

During the February hearing, State Rep. J. Eggleston (R-Maysville) read a letter from a northwest Missouri teacher who was told that she must repay $9,000, because of the state’s error. Representative Eggleston said that day that the teacher wishes she had been denied unemployment, to begin with.

Click here to listen to the short announcement from House Special Committee on Government Oversight Chairman State Rep. Jered Taylor (R-Nixa), which was made on the Missouri House floor on April 15, 2021:

Missouri Senate to hear bipartisan legislation on Wednesday on faith-based boarding schools; Householders remain jailed without bond

April 14, 2021 By Brian Hauswirth

Bipartisan legislation aimed at regulating faith-based boarding schools like the now-defunct Circle of Hope Girls’ Ranch in southwest Missouri’s Humansville will be heard Wednesday by a Missouri Senate committee in Jefferson City.

State Reps. Keri Ingle (D-Lee’s Summit) and Rudy Veit (R-Wardsville) testify before a Missouri House committee in Jefferson City on February 10, 2021 (file photo courtesy of Tim Bommel at House Communications)

The Senate Seniors, Families, Veterans and Military Affairs Committee will hear the bill from State Reps. Rudy Veit (R-Wardsville) and Keri Ingle (D-Lee’s Summit). The Missouri House gave final approval to the Veit-Ingle bill in late March. That vote was 148-0.

Representative Ingle has said that the issue with faith-based boarding schools goes well beyond the Circle of Hope, and that this appears to be a systemic issue.

Current Missouri law doesn’t allow any regulation or oversight on residential care facilities for children, as long as the facilities declare themselves as religious.

“That meant that they had absolutely zero oversight at all,” Ingle told Missourinet in mid-February. “There were no regulations, no oversight. And that means no health and safety standards. No background checks, no criminal background checks.”

The owners of the Circle of Hope ranch remain jailed without bond, after being charged with 102 felonies between them. Boyd and Stephanie Householder are from southern Missouri’s Nevada, which is near Humansville.

Attorney General Eric Schmitt (R) announced the criminal charges in March in Jefferson City, telling Capitol reporters that the charges against the Householders are horrific.

“With 16 victims so far, we believe this to be one of the most widespread cases of sexual, physical and mental abuse patterns against young girls in Missouri history,” Schmitt announced in March.

Boyd Householder is charged with 80 felonies, including 56 counts of child abuse or neglect. Many of the charges are for alleged sex crimes.

Court documents allege that Boyd Householder punished one girl for drinking water, by forcing her to drink 220 ounces of water and then run until she vomited. In another case, duct tape was placed over a child’s mouth for several hours, before Boyd Householder allegedly “ripped the pieces off all at once,” according to court documents.

The 22 felony charges against Stephanie Householder include 12 counts of child abuse or neglect and ten counts of endangering the welfare of a child.

The next court appearance for the Householders is a preliminary hearing, which is set for May 20 in Stockton.

Ingle, the top Democrat on the Missouri House Children’s and Families Committee, was featured during a February episode of NBC’s “Dateline”, for her legislation.

Missouri shares virus aid spending suggestions with K-12 schools

April 14, 2021 By Alisa Nelson

The U.S. Department of Education says Missouri’s K-12 schools will get nearly $2 billion in total federal aid from the latest coronavirus plan. State Department of Elementary and Secondary Education spokeswoman Mallory McGowin said health experts suggest spending some of the virus funding on the basics.

Missouri Governor Mike Parson visits a St. Louis school on July 29, 2020 (file photo courtesy of the governor’s Flickr page)

“The experts shared that while good sanitation in schools is never something that you should omit, purchasing those UV cleaning systems that can be quite pricey or spending a lot of money to do these extraordinary cleaning measures may not be the place to invest your resources. The experts shared that continuing to purchase masks for students, continuing some of those other mitigation strategies would be a better place to drop their dollars into,” she said.

As schools consider what to use the money for, McGowin said many Missouri schools are not set up to have much social distancing.

“If you’re not able to utilize that layer of protection – keeping students and staff at least three feet apart now per the new CDC guidance – then you need to layer on the additional mitigation strategies. That’s when masks become prudent. That’s when the plexiglass barriers and things like that become something you really need to sink your energy into,” she said.

Some Missouri communities and local school boards have lifted coronavirus restrictions. McGowin said now is not the time to ease up school health rules.

“From our perspective and the perspective of the Department of Health and Senior Services, all are in alignment that those mitigation strategies that schools are using and that we’re seeing work must remain in place to ensure that we can continue to offer those in-person learning opportunities safety and with little to no interruption,” she said.

The state strongly encourages the use of face masks but McGowin said there are no financial penalties against schools that do not require masks.

Missouri gaining ground along broadband superhighway, but many more miles to go

April 14, 2021 By Alisa Nelson

A new report says Missouri ranks 32nd in the nation in broadband internet access – a positive step from 41st just a couple years ago. Federal and state aid have helped to boost access around Missouri.

The report says 23% of Missouri students still do not have access to high-speed internet. Plus, it says the state ranks in the bottom five for access to low-cost internet.

Missouri gaining ground along broadband superhighway, but many more miles to go (Photo courtesy of Alisa Nelson)

During a state Board of Education meeting Tuesday, Tim Arbeiter, state Director of Missouri’s Broadband Development Office, said there is still a lot of work to do.

“Within the next three years, I think we could probably cut our divide in half. But I still think we are going to have challenges ahead of us in the affordability space. As I listen to my colleagues across the state, when affordability programs are active and live, there is still some hesitancy from populations to hook on. We don’t know the aspects and the why to that. So, we need to understand that little piece a little bit better,” said Arbeiter.

Arbeiter said Missouri has 255 broadband internet providers, including cable, wireless, electric, and telecommunication companies.

Rob Dixon, the director of the state Department of Economic Development, said Missouri’s economy will not grow without continuing to boost broadband access.

“It’s a key plank in our overall economic development strategy,” says Dixon. “The big question of is it an affordability issue or is it an access issue or is it a device issue. The answer is yes on all of those things. And so, it is a pretty challenging issue all around.”

He said data shows Missouri is a mixed bag in its state of broadband.

“The bottom line message I think that we have is there is still very much a gap that we are trying to close, but we are moving in that right direction. We’re still on the wrong side of that list but we are moving forward. It’s a difficult issue to talk about kind of in a positive way because there is still such a big gap that we are trying to close. I think that’s why there’s so much urgency around this issue,” says Dixon.

Board member Pamela Westbrooks-Hodge of Pasadena Hills said some individuals in the corporate community want to help.

“Maybe where they plug in and play is with these short-term actions,” she said.

Members talked about broadband coverage being spotty from house to house. During the pandemic, some communities have set up portable wifi connections for students to access internet from a building or a parked bus, for instance.

“A lot of homework being done at the McDonalds,” said Board President Charlie Shields of St. Joseph.

To view the report, click here.

Missouri puts the brakes on the use of J&J COVID-19 vaccine

April 13, 2021 By Alisa Nelson

Missouri has suspended the use of the single-dose Johnson & Johnson’s Janssen COVID-19 vaccine until further notice.

“In an abundance of caution and as per federal guidelines, we are pausing vaccination with Johnson & Johnson’s Janssen vaccine until further notice in Missouri,” says Dr. Randall Williams, director of the Department of Health and Senior Services (DHSS). “We anticipate having more information shortly to make further decisions about overall vaccine distribution in light of this new development and will continue to update citizens who have been vaccinated with the J&J vaccine after the advisory committee meets at the federal level tomorrow.”

A press release today from the Missouri Department of Health and Senior Services (DHSS) says a new standing order for this vaccine has been issued by DHSS and is effective immediately.

The announcement comes after a statement from the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration saying the federal agencies are investigating a rare and severe type of blood clot reported in six women that occurred after getting the vaccination. More than 6.8 million doses of the J&J vaccine have been given nationwide.

People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider. Patients with other clinical questions should contact their health care provider or call the COVID-19 hotline at 877-435-8411.

Providers are asked to keep any on-hand J&J vaccine in the appropriate storage unit and label it “quarantine-do not use” until further notice.

DHSS says as the state receives more information, it will be made available. The impact the move will have on Missouri’s mass and mega vaccination events is unknown at this time. Some of those have used the J&J vaccine.

Rehder’s bipartisan needle exchange legislation heads to Missouri House committee

April 13, 2021 By Brian Hauswirth

Bipartisan legislation creating a hypodermic needle exchange program will be heard by a Missouri House committee Tuesday afternoon in Jefferson City.

State Sen. Holly Rehder (R-Scott City) speaks on the Missouri Senate floor in Jefferson City on March 9, 2021 (file photo courtesy of Harrison Sweazea at Senate Communications)

State Sen. Holly Rehder (R-Scott City), who has sponsored the bill for several years, will testify before the Missouri House Emerging Issues Committee. Her two-page Senate Bill 64 has already received final approval from the Missouri Senate.

Senator Rehder tells Missourinet that the needle exchange program would help prevent the spread of HIV and hepatitis. She has said that if addicts have access to clean needles, it would reduce the transmission of those diseases.

Under her bill, any entity that’s registered with the state Department of Health and Senior Services (DHSS) that operates a syringe exchange program would be exempt from the offense of distribution or sale of drug paraphernalia, as long as the entity is not located within 500 feet of a school building.

Groups like St. Louis-based non-profit Criminal Justice Ministry have testified for the bill in previous years. They say it could save the state money in the long run.

What we’re watching this week in Missouri Legislature: federal stimulus funding, state budget and workers compensation issues (AUDIO)

April 12, 2021 By Brian Hauswirth

Testimony involving stimulus dollars under the federal “American Rescue Plan Act of 2021”, alternatives to Medicaid expansion and workers compensation for firefighters and first responders will highlight this week in the Missouri Legislature in Jefferson City.

State Rep. Doug Richey (R-Excelsior Springs) speaks on the Missouri House floor in Jefferson City on March 18, 2020 (file photo courtesy of Tim Bommel at House Communications)

The 2021 session has about a month to go. The last day of session will be Friday, May 14.

A brand-new Missouri House Subcommittee on Federal Stimulus Spending will meet for the first time Monday morning in Jefferson City. They’ll gavel-in at 11 a.m. Committee Chairman State Rep. Doug Richey (R-Excelsior Springs) is humbled by the appointment.

“It is a committee that will be doing some very important work in terms of vetting both the priorities and the need for these federal stimulus dollars that are yet to even be received,” Richey says.

The subcommittee will hear testimony on Monday about capital improvement needs that could be eligible for federal stimulus funds under the Rescue plan. President Joe Biden (D) signed the bill, and House Budget Committee Chairman Cody Smith (R-Carthage) has said that he expects Missouri to receive billions of dollars in federal funding.

“There will be opportunity for several one-time appropriations for capital improvements and deferred maintenance that we know exist throughout the state,” says Richey.

He tells Missourinet that examples include universities, public safety, mental health and hospitals and state buildings.

Chairman Richey is emphasizing the importance of due diligence. He tweeted Saturday that “the American Rescue Plan isn’t funded by tax payer dollars, it’s funded by tax payer indebtedness.”

The Medicaid expansion issue will also come up again this week in the Legislature.

The Missouri House Budget Committee is expected to vote Tuesday on a budget blueprint from Chairman Smith, a plan which directs dollars slated for Medicaid expansion for other programs, including MO HealthNet. That’s the state Medicaid program.

Smith outlined the plan last week. House Bill 21, an eight-page bill, is just over $1 billion. $894 million of that would come from federal funds.

Funding includes $26 million for programs like respite care, adult day care and home-delivered meals. Chairman Smith testifies the funding also includes $88.2 million for funding long-term care services for care in nursing facilities. HB 21 also includes $18 million for k-12 public school transportation, and $2 million for adult high schools. It also includes $11.6 million for treatment for alcohol and drug abuse, and $2.2 million for youth community programs. It also provides about $1 million in additional funding for the State Public Defender System.

State Rep. Robert Sauls (D-Independence) speaks on the Missouri House floor in Jefferson City on March 31, 2021 (photo courtesy of Tim Bommel at House Communications)

House Democrats on the Budget Committee are expected to oppose the plan, saying that 53 percent of Missouri voters approved Medicaid expansion in August. Regardless of the committee vote, the issue will almost certainly be debated again on the House floor soon.

The Missouri House Public Safety Committee will meet Tuesday morning to hear legislation from State Rep. Robert Sauls (D-Independence), which involves workers compensation for firefighters and first responders.

“This is a bill that protects those who protect us. The firefighter cancer presumption bill creates a presumption that if a firefighter develops cancer, he or she got it as a result of the hazardous toxins of which he or she was regularly exposed. There is also a component to PTSD for first responders. I am proud of this bill and it is far overdue,” Sauls tells Missourinet.

Sauls’ House Bill 863 would allow Missouri firefighters and first responders to receive workers compensation for diseases of the heart or cardiovascular system, any infectious diseases, diseases of the body systems or organs from carcinoma, and diseases of the lungs or respiratory tract.

Across the Capitol Rotunda in the Missouri Senate, the chamber is expected to take up legislation involving mechanical contractors early this week. Senate President Pro Tem Dave Schatz (R-Sullivan) tells Missourinet he expects his Senate Bill 11 to hit the floor on Monday.

Schatz’s bill is called the “Missouri Statewide Mechanical Contractor Licensing Act.” Under the bill, the statewide mechanical license for mechanical contractors would be regulated by the Division of Professional Registration, within the state Department of Commerce and Insurance. The bill creates the Office of Mechanical Contractors, within the division.

Pro Tem Schatz also says education reform legislation could go to the Senate floor this week.

Click here to listen to Brian Hauswirth’s full four-minute interview with Missouri House Subcommittee on Federal Stimulus Spending Chairman Rep. Doug Richey (R-Excelsior Springs), which was recorded on April 9, 2021:

Rural lawmaker says shortage of gas stations near Missouri-Iowa border is a safety issue

April 12, 2021 By Brian Hauswirth

(News director Bob Ehle at Missourinet Moberly affiliate KWIX contributed to this story)

A state lawmaker who represents four rural northern Missouri counties is warning about the lack of gas stations near the Missouri-Iowa border, saying it’s a safety issue in his farming district.

State Rep. Danny Busick (R-Newtown) speaks on the Missouri House floor in Jefferson City on February 9, 2021 (file photo courtesy of Tim Bommel at House Communications)

State Rep. Danny Busick (R-Newtown), the Missouri House Special Committee on Small Business vice chairman, says regulations make it difficult to operate small, rural gas stations.

“Like I have to drive 25 miles … whether it be Milan, Unionville or Princeton to get gas. And within that 25 miles, there’s six little towns there that have gas stations located in them,” Busick tells our Moberly affiliate KWIX Radio.

Busick tells Missourinet that gas stations in those towns like Humphreys, Powersville, Galt and Newtown have closed in recent years. He says drivers can run out of gas and that it’s a safety issue.

“This area includes (the) western part of Putnam County, eastern part of Mercer County and most of western Sullivan County.” says Busick.

He says some of the gas stations that have closed were operated by families who have died. He says those stations were grandfathered in and that they should be grandfathered in again, to another owner.

Representative Busick is hoping to raise awareness about the issue. He’s also spoken about the issue on the Missouri House floor in Jefferson City.

School nurse group hopes Missouri districts will put federal aid toward hiring nurses

April 12, 2021 By Alisa Nelson

Missouri’s K-12 schools are getting a big chunk of change in the latest federal coronavirus relief package. The U.S. Department of Education says $1.95 billion total has been designated for Missouri schools. The plan also includes funding for a program to increase student internet connectivity for virtual learning and aid for nonpublic schools.

Missouri Governor Mike Parson speaks to schoolchildren and teachers in mid-Missouri’s California School District on September 9, 2020 (photo courtesy of the governor’s Flickr page)

Linda Neumann, with the Missouri Association of School Nurses, says the group hopes the state’s school districts will consider using some of the federal funding to hire school nurses.

“The Missouri Association of School Nurses is hoping that in Missouri, they will invest the federal funding in a way that will effectively achieve safer classrooms in schools, to improve the physical and mental health and academic success of children. Part of this involves hiring school nurses in those schools that do not have access to a school nurse,” says Neumann. “If they need school nurses or if they need a counselor or maybe they can expand the number of school nurses they have so that one school nurse doesn’t have to cover three schools.”

Neumann tells Missourinet a 2020 state Education Department report shows about 20% of Missouri public school districts do not have a nurse.

“For some students, the school nurse is their actual health care home because of lack of access in their community, especially in some of our rural communities. That tends to be where there is a lack of school nurses right now, where not every town has a doctor, dentist, or a pharmacy, but they have a school. If that school has a registered nurse there to take care of those kids, that school nurse can really fill in the gaps, find resources, and have resources brought in. “It’s not that schools don’t appreciate having a registered nurse there. It is often a budget issue,” she says.

Neumann says in the early 1990s, about 50% of Missouri public school districts did not have a school nurse on hand. Then, an effort began to tax smokeless tobacco products and designate that revenue toward putting more nurses in schools.

In 1995, Missouri allocated $5.4 million annually for 15 years for school health services, which increased school nurses in schools to 99.7%. That funding ended in 2010. As a result, not all school nurse positions were sustained.

For the schools without a registered school nurse, some have a health aide. Others rely on their principal or an administrative assistant to field health problems. Without a school nurse, Neumann says the level of expertise and care the kids are going to receive is not going to be the same.

According to the state Department of Health and Senior Services, there are more than 72,000 Missouri K-12 public school students with asthma, some 27,000 have life-threatening food allergies, about 7,300 suffer from seizures, and more than 2,200 have Type 1 diabetes.

“This doesn’t even mention the impact that COVID-19 has had on kids,” says Neumann. “COVID-19 has definitely disrupted learning of students and compromised their physical and mental health. We have seen anxiety and depression go up tremendously in our state both in children and adults during covid.”

Neumann says having a school nurse on staff helps to reduce student absenteeism.

“When a registered nurse is there to help manage those chronic health conditions, like asthma and diabetes, those are things that the healthier we can keep the kids the more they can be in school,” she says.

Neumann cites The Journal of American Medical Association showing the benefits of investing in a school nurse.

“Their determination was that in schools, for every dollar invested in a full-time registered school nurse, that society would gain $2.20,” she says.

When administrators or school boards are determining how many school nurses are needed, Neumann says the schools should keep in mind student safety.

“That means nurse to student ratio and it really varies depending on the health needs of the students and the social determinants of the population,” she says. “If you have 700 kids that are all well, one school nurse is sufficient. But if you have eight kids with Type 1 diabetes, three with seizure disorders, three with sickle cell, a kiddo with chemotherapy – there are just so many factors that play into that.”

Missouri has about 550 traditional public school districts and charter schools serving roughly 900,000 students.