Is the Clinic Still Needed?

St. Peter’s Free Clinic opened 11 ½ years ago with a mission to provide healthcare services to the low-income, uninsured residents of Hillsdale County. During this time, we have provided nearly 29,000 visits to 4,385 individuals and dispensed medications with a retail value of $9.8 million.

So, now the question is: do we still need the clinic?

The easy answer is yes; but it is much more complicated than that.

We serve a very vulnerable population, and we have no desire or plan to go away anytime soon. When I spoke with JJ Hodshire from Hillsdale Community Health Center, he said, “We continue to support St. Peter’s Free Clinic and see the clinic as an important part of the healthcare safety net in the foreseeable future.”

What he meant by that is that the clinic is part of the healthcare safety net system, made up of public and private institutions that deliver care in a variety of settings to individuals who are otherwise unable to afford or access care. Healthcare safety net providers, such as St. Peter’s Free Clinic, serve a diverse population including the working poor, the homeless, the undocumented and the uninsured, and in some cases, those with Medicaid. This group is included because of the difficulty in obtaining care – many providers choose not to provide care to those with Medicaid. In the past, the clinic has only provided care to those with Medicaid if they had a spend-down that made access to care impossible. We will evaluate the future of providing care to those with Medicaid as the situation plays out… can they access care? Can they afford care? Can they afford medications?

There are some who will remain uninsured either because of eligibility restrictions, insufficient subsidies that cause premiums to be unaffordable, or other barriers.

Some who “fall through the cracks” of healthcare reform include: the patient I have worked with to access healthcare through the Marketplace – with the subsidies, her insurance was going to be around $42/month. But, before her first premium was paid, the brakes went out on her car, and she had to have that fixed, in order to keep her job. She was living paycheck to paycheck – or more likely, paycheck to Thursday. And, she couldn’t pay the healthcare premium. She called the insurance company, but her policy was cancelled. Then, her hours were cut – from 40 per week to 25 per week. She now has no money to pay for healthcare, she isn’t eligible for additional subsidies because of the cancellation for non-payment of her premium, and she doesn’t qualify for Medicaid, even with her reduced hours.

Prior to the implementation of the Affordable Care Act, there were 41 million uninsured individuals in the United States; free clinics across the nation provided care to approximately 1.5 million of the uninsured. The Congressional Budget Office (CBO) predicts there will still be an estimated 29 million people in the United States without health insurance by 2019. So, even with the decrease in the number of uninsured, the need for free clinics will still exist.

The experience of free clinics in Vermont, Wisconsin, and Massachusetts – states where most of the uninsured received coverage due to federal waivers to expand Medicaid prior to implementation of the Affordable Care Act – show us the following:

v None of the free clinics closed; in fact, volume continued to grow.

v Free clinics helped enroll and navigate patients through the changes.

v Primary Care Provider (PCP) shortages, especially of PCPs who will accept Medicaid, resulted in free clinics providing care to Medicaid patients but not billing.

v Dental Care and Prescription Assistance remain huge gaps in service.

 

Today, the clinic continues to serve as many people as ever. For the first quarter of this year, we have seen an average of 57 patients per week with 73 new patients so far this year. We have dispensed medications with a retail value of $390,000.

Connie and I took the training in November to become Certified Application Counselors, and assisted individuals in applying for healthcare coverage through the Marketplace. We are continuing to assist with enrollment in the Healthy Michigan Plan, which is the Michigan version of Medicaid expansion – a program that provides healthcare to low-income working families. We have assisted over 60 individuals and families with applying for and enrolling in healthcare.

Obviously, the future of the clinic depends greatly on the availability of ongoing and sustainable funding. While the perception may be that the problem is fixed, it will not be an instant fix. It will take us months, probably years, to get everyone enrolled, and there will always be those who fall through the cracks. The support of our community is more important than ever.

Moving forward, the clinic will continue to provide healthcare, medications and other services to those who remain uninsured, as well as screening, enrolling in the appropriate healthcare product, and assisting with the transition to a primary care provider.

Enrollment in insurance through healthcare.gov is closed for now; the next open enrollment will begin November 15, 2014. The Healthy Michigan Plan enrollment is open all year round, so we will continuously be identifying those eligible for that program and assisting them as needed with enrollment.

The clinic is also looking at other services that are needed – we are offering a smoking cessation group; education on becoming a healthcare consumer; and we continue to assist individuals with finding the resources they need for a variety of issues including dental care and mental healthcare.

Moving forward, the board is constantly asking and discussing the future of the clinic, with questions such as:

—  What is the impact of the Affordable Care Act on our clinic?

—  How many of our patients will receive insurance coverage under the Affordable Care Act?

—  Where will they find care?

—  Who will remain uninsured in our community?

—  Will our clinic be needed post-2019?  Who will we serve?

—  What do we need to do to prepare for changes brought on by the Affordable Care Act?

—  What options are open to us for the future?

 

We are really excited as we help people access healthcare insurance; it has been a frustrating, crazy, but exciting, time. And, we look forward to continuing to provide healthcare to the low-income, uninsured residents of Hillsdale County – for as long as we are needed.

On Being Invisible

I know a little bit about being invisible. When I first moved to this community, I would be introduced to people for the second, third, fourth times and they would always say, “Nice to meet you.” I wanted to scream, “You have already met me” – a number of times, but I didn’t. I just lived with being invisible. If you didn’t grow up here, it was hard to fit in.

Now I am the one treating people as though they are invisible… I never meant to, but as I have been helping people enroll in the Healthy Michigan Plan (Michigan’s version of Medicaid expansion) I realize that I am asking people if they are clinic patients, when they have been patients for a long time.

I no longer know the names and faces of the patients here. In the early years, I knew them all. Most of them by name, but I at least recognized everyone.

That is no longer the case. Today we see 3-4 times as many people a week as we did in the beginning. The rational part of me knows that I cannot know each and every one of them. So my prayer is that they are seen and recognized by someone here. Please Lord – let us see them.

There is nothing more life sapping than being invisible. So, whether it is the homeless man on the corner or the clerk at the check-out counter, acknowledge them; ask about their day; somehow let them know that they are not invisible – that they too are a child of God and you see them.

A Success Story

There are lots of success stories here at the clinic, but I don’t always get to hear them. The frontline people are much more likely to hear the stories.

But, this was a patient that I had gotten to know over the years. She was always vivacious, personable, and friendly. When she was a patient here, she was struggling in her life.

Turns out, her life had always been a struggle. As a young woman she had been into drugs and alcohol until age 22, when she married and had her children. She stopped using drugs, stopped drinking and raised her family. But, as they got older, and the man she was married to became increasingly controlling… she turned to alcohol again.

She had a job in the food service industry – low pay, no benefits. Her health problems brought her to the clinic a few years ago. We helped her through some of that time. She ultimately went to AA, left her husband, and got a job in food service in the prison system. She finally had health insurance, and no longer needed us.

I heard from her about a week ago. Her life has continued to change for the better. When the state privatized the food services in the prison system, she lost her job. But, they gave her the opportunity to become a corrections officer. Turns out, that is what she was meant to do with her life. She loves it!

She is making good money, has great benefits, loves her job and has been sober for four years. She credits AA with her sobriety and the improvement in her life.

So often when people leave here, we don’t know what happens. It is so nice to hear these stories – to see people succeed, despite all the odds.

Tears

Two people just walked out of my office in tears.

They were tears of joy: they were both approved for the Healthy Michigan Plan. For the first time in years, they have healthcare coverage. This is a life-changing moment for both of them.

He has a long-standing heart problem, and will now have access to the care he needs.

She is disabled, trying to get disability insurance. She has not been able to work in over two years and is basically homeless – living with a relative or a friend, wherever she can land for a while.

I am smiling because they now have healthcare, but I have to tell you – I am dying inside, because these people live in my community, in my world, and I am so unaware of the difficulties, the circumstances, and the utter hopelessness that people are just barely surviving in.

How does this happen? What can I do to change it? Questions… no answers.

Helen

Helen was here for the first time last week. She is 49 years old; divorced, with a significant other of 18 years; no mention of any children. She was sent here by her primary care provider due to a low hemoglobin. (Hemoglobin is the protein in red blood cells that carries oxygen. A low hemoglobin count is a below-average concentration of the oxygen-carrying hemoglobin proteins in the blood.)

She shared her story with us. She had been taking care of her father who had recently died from pancreatic cancer; after his death, her mother was diagnosed with “the most aggressive form of breast cancer” – she told me that her mother nearly died from the chemotherapy she received, but is now doing well. Also during this time, her significant other suffered a massive stroke, and has been left partially paralyzed on one side.

She has had a bit of stress in her life.

She began feeling ill and was seen by her healthcare provider. Blood work done at that time showed a low hemoglobin, which can be indicative of bleeding somewhere in the body. Without further testing, they could not identify the source of the bleeding. She was uninsured, so was sent to the clinic for testing.

We were able to start the testing, but some of the tests needed are difficult to access without healthcare insurance. We were also able to connect her with the local mental health access point, and that was definitely a resource she needed.

She is anemic, anxious, fatigued and scared. Scared that she too has cancer. Scared that the delay in diagnosis could affect the outcome.

But, she is also grateful – grateful for the healthcare provider who has been seeing her; grateful for the clinic; grateful for the support of the mental health professional; and grateful that she will qualify for the Healthy Michigan Plan and will finally have access to healthcare.

A thank you

Tuesday night we received a card with this note: (I have left it as written)

To All of the Wonderful Souls Who Make-up the Clinic Staff:

Thank each of you so very much for the kindness and compassion served to me as well as the health care you so generously provided both me and my husband.

I've been coming to the clinic monthly for over five years now. I truly don't know how we would have gotten by so well without the generosity of the clinic and all of it's contributers.

Today I did a little calculating - 60 months @ approx. $50.00 per month for my prescriptions = $3000.00* That is just an estimate - I really don't know what my prescriptions run at the pharmacy.*

That isn't even to mention all of the blood tests run, etc.

Thanks to each of you for being such a huge step of help for the residents of Hillsdale County.  And for my husband and I personally.

Love,
Candy

PS: To those of you with whom I have shared the story of my daughter's battle with cancer...she passed away just a week ago today. She was still fighting the cancer; it was the chemo and a lack of immunity that did her in. She is free of pain now -- Thank you for your prayers.

xox

This was her last night being seen at the clinic; she is now eligible for Medicare.
Sometimes, you just don't know what people are dealing with.......

Healthy Michigan Plan: New Health Insurance for Michigan Residents

Have you heard of the Healthy Michigan Plan? It’s a new, low-cost health plan designed for low-income Michigan residents. Nearly half a million Michigan adults will be eligible for coverage beginning April 1, 2014.

 

Available through the state of Michigan, the Healthy Michigan Plan covers those who make up to 133 percent of the federal poverty level. That works out to roughly $16,000 a year for one person or $33,000 for a family of four.

 

The Healthy Michigan Plan covers everything from doctor visits to hospitalizations to prescriptions at a low cost. To apply, there are three options for Michigan residents:

 

·        Apply online at www.michigan.gov/mibridges

·        Apply by phone at (855) 789-5610

·        Visit your local Department of Human Services office

 

The Healthy Michigan Plan includes most benefits associated with traditional health insurance plans at a more affordable cost, based on household income. Those who make between 100 and 133 percent of the federal poverty level will contribute up to 2 percent of their income to a health savings account, which can be used to pay for out-of-pocket medical expenses. The plan offers incentives for healthy behaviors, such as losing weight, quitting smoking, and preventive measures, such as getting a flu shot.

 

The 10 Essential Health Benefits covered in the Healthy Michigan Plan are: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services, including oral and vision care. The Healthy Michigan Plan will cover other medically necessary services as appropriate.

 

For more information about what the Healthy Michigan Plan covers, who is eligible, and to apply, visit www.HealthyMichiganPlan.org.