The purpose of PRH Change Notice 05-12 dated March 27, 2006 was to “abolish the major medical reimbursement policy and clarify procedures for addressing health and medical costs exceeding the basic health services provided by Job Corps centers”.

In the past, if a medical emergency or unanticipated serious illness occurred, Job Corps centers were to assist the student in seeking third-party insurance or other coverage and , if necessary, cover the first $3000.00 of major medical expenses. Centers could then seek major medical reimbursement from the Regional Offices for any amount greater than $3000.00 or from the National Office for any amount greater that $25,000.00.

A review of major medical reimbursements for the past three program years revealed that:

1. Some Job Corps regions had not had any major medical reimbursements, and
2. Some Job Corps centers were requesting major medical funding for incidents where students should have been medically separated or medically separated and referred to OWCP.

The change to PRH 6:6.12 follows:

R4. Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps Centers

1. Centers will seek third-party health insurance coverage for students who have medical needs or costs beyond the basic health services provided by the center.
2. If a student is determined to have a pre-existing or acquired health condition that significantly interferes with or precludes further training in Job Corps, or if a student is determined to have a health problem that is complicated to manage or for which necessary treatment will be unusually costly, the center must follow medical separation procedures (PRH 6.12, R11 and PRH 6.4, R4(c)(5)), including determining whether reinstatement is appropriate (PRH
       6.4, R4(c)(5)) and whether referral to the Office of Workers’ Compensation Program (OWCP) is required (PRH 6.12, R8).

If the center’s health budget becomes overspent, the center may request, through the Regional Office, additional funding.  The center would need to submit, through appropriate channels,  a detailed report outlining the reasons for the expenditures, which will be reviewed by the Regional Health Consultants.

Below are some interventions to be considered if a student acquires a serious health condition while on center that interferes with or precludes further training and is costly or complicated to manage:

1. Place on a 10 day medical leave
2. Medical Separation with Reinstatement Rights
3. Private insurance
4. OWCP
5. Negotiate with local resources, i.e. center physician, urgent care centers, hospitals, etc.
6. Discuss indigent care with local providers

Important considerations:

1. Medicaid is always the payer of last resort.
2. Thorough review of the applicant folder and an interactive interview with the applicant by the Health and Wellness Manager and the Interdisciplinary Team, if necessary.