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Handle With Care

December 2018

By Nancy Mann Jackson

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Institutions are developing procedures to appropriately manage an increasing number of medical withdrawal requests from students.

Among students who enrolled in a college or university in fall 2010, only 54.8 percent completed a degree or certificate within six years, according to Completing College: A National View of Student Rates by Race and Ethnicity—Fall 2010 Cohort, a 2017 report from the National Student Clearinghouse Research Center. Data from the report show that completion rates varied widely along racial and ethnic lines; college student withdrawals don’t always depend on socioeconomic backgrounds.

In recent years, institutional leaders say that they’ve seen a stark increase in the number of college students who are withdrawing due to medical reasons. No widespread study shows the prevalence of medical withdrawals, but professionals at numerous colleges and universities share anecdotal evidence of the trend, with many enacting new policies to more efficiently handle the associated workload. For institutions, a rise in medical withdrawals doesn’t just affect college completion rates; it also affects day-to-day schedules and staff resources.

For instance, campus leaders at Texas Tech University, Lubbock, created a committee a couple years ago to better manage the influx of medical withdrawal requests, says Christine Blakney, managing director of student business services. She attributes the increase to a greater number of mental health concerns among college students, and her counterparts at other institutions echo this concern. (Read also “Counseling Counts.”)

Vanderbilt University, Nashville, has long offered an optional tuition insurance plan for students, and in recent years the institution has seen an increase in the number of claims filed by students who have opted for the plan, says Chris Cook, university bursar. “I cannot be 100 percent certain about why the number of claims has increased. However, multiple conversations with our insurance provider suggest that it may have to do with an increased number of withdrawals for mental health reasons,” he says.

Nationally, student use of campus mental health counseling centers increased by an average of 30 to 40 percent between 2010 and 2015, while enrollment in colleges and universities increased by only 5 percent, according to Pennsylvania State University’s Center for Collegiate Mental Health 2017 Annual Report. The report also shows that anxiety and depression are the most common concerns among college students who seek mental health counseling on campus. These are the only mental health concerns that have demonstrated a clear growth trend over the past four years.

Managing Requests

As college students deal with higher instances of anxiety, depression, and other health concerns, institutions are grappling with how to best manage their requests to withdraw and receive refunds on tuition and fees. To improve the consistency of decisions, a newly formed committee at Texas Tech has been tasked with reviewing each case of medical withdrawal individually. The committee includes representatives from various offices, including the dean of students, registrar, student business services, academic departments, and financial aid. “This committee reviews all the circumstances and considers the various academic and financial impacts to the student in determining the actual date of withdrawal to post,” Blakney says.

In addition to submitting a request to be reviewed by the committee, students must fulfill a standard documentation requirement to support any medical withdrawal appeals, which may include providing health provider verification or hospital bills. To ensure student confidentiality, these documents are handled solely by the office of the dean of students. (See sidebar, “Safeguarding Student Information.”)

Business services leaders at Texas Tech felt it was important to include representatives from a number of different departments in the process, Blakney says, since a withdrawal can have numerous consequences for the student. The consequences can be academic or financial, affecting a student’s registration status, return of financial aid to Title IV, and loan repayment status. To ensure the least negative impact to the student, each student appeal for withdrawal must be reviewed carefully.

“If the appeal is granted, the committee approves a backdated withdrawal request, which generates a reduction of the charges based on the approval date. Any refund or reduction of charges then follows our general university policies based on drop or withdrawal dates for the term; those policies are not impacted by the reason for withdrawal,” Blakney says. “When an appeal is not granted,” she adds, “it is because there was a lack of documentation or because the appeal was not filed on time.”

At Vanderbilt, leaders often rely on the tuition insurance plan to handle refunds for students who need to withdraw for medical reasons. “Internally, we do not handle medical withdrawals any differently than we do other types of withdrawals,” Cook says. “Tuition and fees are prorated based on the date of withdrawal up through roughly 60 percent of the semester. Any withdrawals processed after that point do not receive any type of refund for tuition and fees directly from the university. However, if students have opted in to the tuition insurance plan and have to leave for medical reasons before the semester is completed, they may be able to recoup some of their money.”

Each year, the insurance company’s underwriters evaluate participation and claim levels and provide the university with coverage options for the coming terms. The current plan covers 80 percent of the insured amount—so students who withdraw after 30 percent of the semester is complete receive a 70 percent refund from the university. With a qualified claim, the insurance company could refund an additional 10 percent for a total of 80 percent.

A Change in Policy

In 2016, Elgin Community College, Elgin, Ill., changed its medicalwithdrawal refund policy to address “a significant increase in requests for medical withdrawal refunds over many years,” says Kimberly Wagner, executive director of Student Financial Services and Auxiliary Enterprises. The college’s new policy allows refunds for only three reasons: (1) death of a family member, (2) documented medical diagnosis, or (3) to be a caretaker for a family member. The Tuition Adjustment Advisory Council (TAAC) at Elgin reviews appeals for tuition-only refund adjustments based on a medical or family emergency. The committee includes four administrators, including at least one member from student financial services and one from student services, which includes a student success department. The committee meets at least twice a month to resolve outstanding appeals.

In addition to limiting the reasons for granting refunds, the new policy also limits refunds to one per student during enrollment at Elgin. Previously, the college used to allow multiple refund appeals and had a broader array of circumstances that were eligible for refund appeals. The changes have helped reduce the number of appeals: In FY15, there were 225 appeals for medical withdrawals, and in FY18 the number dropped to 42.

Elgin has relied on a team effort to ensure that student needs are met on all fronts. First, the student accounts department receives and vets the appeal form submitted by the student. Next, if the student receives financial assistance, financial aid staff review the appeal to see if the withdrawal or a refund will cause any unintended consequences for the student. In many cases, the student success department has already counseled the student before a withdrawal request is filed. “Before the TAAC committee meets, the student success director reviews any meeting notes from academic advisers, as well as the student’s academic history. This helps provide context to the committee members as they review the appeal,” Wagner says.

Adding a student services representative to the committee was an important change. “According to the student success department, the number of students seeking or being referred for assistance based on medical-related issues is certainly on the rise,” Wagner says. “We chose to change the TAAC policy from merely an exception to a financial refund policy in order to look at each refund request through the lens of student success. This has proven to be not only a financial gain for the college—with fewer students appealing because they are frequently counseled by the student success director—but also a benefit to students over the long term as well.”

Offering Assistance

In addition to rethinking the withdrawal process, some institutions are looking for other ways to assist students who are facing medical issues and need to take time off from school. For instance, Texas Tech is thinking about new marketing strategies that will help promote their optional tuition insurance. “We do offer it currently, but it is not marketed, and very few students realize that it is available,” Blakney says. “By heavily marketing the option to purchase tuition insurance, our expectation is that the number of appeals will decrease. Students will deal directly with the insurance provider to recoup any payments, and the institution will retain the tuition and fees assessed, instead of losing out on that revenue.”

At Elgin, leaders are taking strides to provide extra assistance for students with mental health issues. “Our committee is seeing many more students facing mental health issues,” Wagner says. “With the student success [representative] on the TAAC committee, there is an opportunity for additional outreach to students and for wellness professionals to provide options. This provides wraparound services to our students.”

Overcoming Challenges

Even with changing approaches to handling student medical withdrawals, institutions still face challenges such as potential inconsistencies in making withdrawal decisions. For instance, some students at Texas Tech appeal directly to their deans, who may make an independent decision rather than referring the students to the withdrawals committee, Blakney says. When a student’s appeal for a withdrawal and refund goes through a noncompliant process, there’s a possibility that he or she could be treated differently from others with similar requests.

Another challenge is making students aware of how a withdrawal will affect them both academically and financially, and what their responsibilities are for providing appropriate information and meeting deadlines to receive a refund. Many students don’t understand the impact of a particular withdrawal date, or they may not list “medical” as their reason for withdrawal, Blakney says. “Many students simply list ‘personal’ as a reason or do not indicate a reason. Those withdrawals are simply processed using the date received and may or may not result in any refund or reduction of charges to the student,” she says.

When students withdraw from the college without an explanation, they are often surprised when they do not receive their anticipated refunds or when they are contacted by a collections agency due to an outstanding balance, Blakney says. At that point, if the student did not withdraw before the refund deadline and did not indicate a medical reason for withdrawal until months later, it may be too late to remedy the bill.

In addition, there could be potential errors in federal or state reporting due to backdated withdrawals, as well as increased staff time to participate on the committee and in processing the appeals that are approved, Blakney says. Offering tuition insurance to students may be one resource to help overcome all these challenges.

At Elgin, the committee has also faced difficulties in finding objective criteria to approve an appeal when a student doesn’t provide adequate diagnosis paperwork from a doctor. “If a student is enduring a situation outside of the TAAC procedure, the committee struggles to assist the student when a financial remedy may not be an option,” Wagner says. “This is where the connection with the student success department representative within student services is instrumental in becoming a member of the committee.”

Looking Ahead

Based on recent history, institution leaders expect that the number of medical withdrawals and related refund requests will continue to increase, “for the near future at least,” Cook says.

Institutions with systems that are working well plan to stay the course. Vanderbilt, for instance, will likely continue its current practice of not distinguishing between medical and other forms of withdrawals, at least for financial purposes, Cook says. “By offering optional tuition insurance, we are able to assist those students who wish to protect themselves from financial penalty due to withdrawal for medical reasons, so we will likely continue to offer this as an option as long as the plan remains sustainable.”

Texas Tech plans to continue relying on its review committee to make decisions about medical withdrawal refunds and will explore the possibility of marketing tuition insurance to students and their families. Through this ongoing process, leaders at the institution have learned that granting refunds for medical withdrawals is both a science and an art. “You have to be consistent, but know that each situation is going to be unique,” Blakney says.

NANCY MANN JACKSON, Birmingham, Ala., covers higher education business issues for Business Officer.

Related Topics

In addition to limiting the reasons for granting refunds, the new policy also limits refunds to one per student during enrollment at Elgin Community College.