Commissioners discuss public‑health nurse recruitment and billing options as Medicaid changes loom

Public‑health staff updated the Carter County Commissioners about ongoing recruitment challenges for a part‑time public‑health nursing position and discussed billing practices for uninsured patients.

Staff (S6) said the ad for the part‑time nursing post (up to eight hours per week) has been running since September with little interest and suggested pausing paid newspaper placement to focus on a concise print notice directing applicants to a county hiring page. Commissioners and staff discussed building a job page on the county website and using a standing, small print ad in the paper to direct applicants to the web posting.

Commissioners and staff also discussed billing practices. Public‑health staff explained a standard admin fee (currently $40) covers supplies and that reimbursements vary by insurer; Medicaid and state vaccine programs cover some vaccines but not all supplies. Staff described that uninsured patients may not produce recoverable revenue and that practices vary across counties — some use sliding scales, some bill flat fees, and some absorb costs. Commissioners asked whether the county should bill remaining balances or adopt a donor/donation approach and requested guidance tied to commission policy and budget priorities.

Several speakers noted uncertainty arising from proposed federal and state changes to Medicaid, which could increase the uninsured population and shift costs to local providers; commissioners asked staff to monitor policy developments and return with recommendations on billing strategy and job‑posting approach.

The commission did not adopt a billing policy at the meeting but encouraged staff to pause expensive advertising until the county website job page is ready and to bring options back for decision.