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Mission CISD close to $1 million deficit — again

For more than two years, Mission CISD has struggled to gain control of the deficit in its self-funded health insurance fund. And although the district made strides to improve the fluctuating net position, administration still seeks long-term solutions to overcome the now $986,761 deficit. 

In 2021, the board of trustees approved a transfer of monies from the general fund to cover the then-$1.5 million deficit. It brought the self-funded health insurance fund back to good standing. But slowly, the deficit crept up again. 

Then in February 2022, the district implemented a solution to reduce the then-$1.1 million deficit. Again, the plan worked — for a while. After Mission CISD changed the prescription benefits plan, the net position improved; eventually, the fund was back in the black in June 2022. But it was a short-lived victory. Since November 2022, the deficit has gradually increased and now sits at just under $1 million.  

The main reason for the deficit is because of high-cost claimants — at the moment, the district has nine. A high-cost claimant is a person with expenses greater than $50,000. But when a high-cost claimant reaches a specific threshold, the employer receives a stop-loss reimbursement. 

Fortunately for Mission CISD, three large claimants recently met the $250,000 deductible to earn stop-loss reimbursements that total $705,024.81. With the credits, the deficit should decrease significantly. 

But Mission CISD still seeks more sustainable solutions to the problem. 

“The medical professionals told us during the pandemic people didn’t take care of their health because we were afraid to go to a doctor’s office and pick up more viruses,” Superintendent Dr. Carol Perez said. “So we know, for almost two years, we really didn’t do checkups and so forth. They told us there’s going to be a huge increase in chronically ill patients, and now we’re living it — last year, this year, probably next year. So what we need is cost-saving strategies — prevention.”

The MCISD finance department and consultants from Carlisle Insurance determined the best way to improve the financial position of the self-funded health insurance is by modifying the current plan design. Since Mission CISD moved from fully-funded health insurance to self-funded health insurance in 2014, they have not changed the plan or increased employee contributions. And throughout this time, the district has incurred the increasing medical and pharmacy expenses, not the employees. 


Mission CISD’s cost-saving strategy is two-tiered — they have preventative measures and plan modifications. 

With preventative measures, the hope is employees and their families on the insurance plan will stay healthier for longer, and, in turn, save on medical expenses. The district has already implemented prevention strategies such as wellness events, campus wellness rooms, vaccine clinics, blood pressure checks and annual mammograms.  

With plan modifications, the district has already changed the pharmacy formulary to save on prescription costs. They are also looking into adjusting employee and employer contributions. And they are looking into a direct contract with a hospital to negotiate lower prices. 

Additionally, administration proposed a case manager position to help keep employees accountable and on track with medication. Perez explained that she once worked with a district that had a case manager who discussed employee needs following a doctor visit. She said it felt like the employer cared about keeping their employees healthy. 

“It’s an investment. And then you start looking at the end of the year and you compare. How did it make a difference? And sometimes it really takes from three to five years to really make an impact. But you start making an impact,” the superintendent said. “And then not only is it financially, but you also look at absences. When people start taking care of themselves, you start reducing employee absences. What does that mean for the children? They learn more. So there’s a lot of benefits, not only reducing the health cost.”


Regarding pharmacy claims, Deputy Superintendent for Support Services Lorena Garcia explained that diabetes is the leading pharmaceutical expenditure for the district. Last quarter, MCISD spent almost $1.5 million on specialty diabetes drugs. The second largest pharmaceutical expenditure was for autoimmune disorder medication, such as Humira. One claim for Humira is more than $6,000 — the employee pays $80, and the district pays the rest. 

“That’s huge, we need to get a handle on that,” Garcia said. “[The risk manager’s] department of course does a lot in terms of outreach and wellness but we need to have conversations with every single family on the plan and make sure that we steer them towards eating healthy and making sure they’re doing their diabetes management, high blood pressure and so forth.” 

At the April 19 board of trustees meeting, Coordinator of Risk Management Sylvia Cruz presented two cost-saving opportunities for specialty drugs with no generic alternatives — split-fill programs and flex access.  

A split-fill program allows pharmacies to fill half a prescription and check in with a patient to ensure the medication is right for them before continuing with the full prescription; this means the pharmacy only bills for half as well. With the split-fill program, it eliminates waste in the event a patient needs to change prescriptions at the halfway point, and it saves the district and employee money. 

Flex access unlocks copay assistance programs for district employees across multiple dispensing channels. In short, the drug manufacturer will send the district coupons to reduce the cost of Mission CISD’s share. If the MCSID had a flex access program during the 2021-2022 school year, they would have saved about $155,225. 

Administration will spend the next few months combing through cost-saving strategies and providing monthly updates at the board of trustees meetings.  

“Every dollar counts,” Perez said.

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