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CommunityA bumpy road for region’s uninsured
Care available, patience needed
Friday, Sept. 5, 2008
 Click here to enlarge this photo Staff photo byGARY SMITH
Dr. Kathleen Snellings looks at the teeth of Health Partners staff member Darlene Kost. Snellings volunteers at the free clinic in Waldorf to provide dental services for children 2 to 10 and hopes to expand the program to others in the future.
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This 2007 figure, the most current available from the U.S. Census Bureau, is going up as the economy takes a downturn, health officials said. The unlucky among the statistics come from all categories – men, women, children, people with jobs and those with disabilities, those without a place to call home and those with deep roots in Southern Maryland.
There is help out there, especially for children, through county nonprofit agencies as well as state and federal programs. Navigating a way through the process, however, can be time consuming.
‘Yes, they’re going untreated’
John Peterson’s story starts about eight months ago when he was released from jail in Charles County. He had a decent job as a plumber and was part of the steamfitters union, and, even more importantly, had good health insurance. That was before he was arrested and jailed on theft charges that he said stemmed from a drug habit.
Peterson knew he had hepatitis C, which had been dormant in his body for at least 14 years. He said either the stress or some other factor triggered the disease while he was in jail and it became active, causing swelling in his hands and feet along with other complications.
‘‘The one time in my life I need [health insurance], I don’t have it,” Peterson said.
While in jail he lost his job and insurance and was unable to sign up for COBRA, the Consolidated Omnibus Budget Reconciliation Act health benefit provisions, which provides certain former employees, retirees, spouses and dependent children the right to temporary continuation of health coverage at group rates. During that time his trailer was foreclosed on, too.
So when he was released, he was on his own. He was told to go to the county social services agency for help with his disease.
‘‘This is where I run into the first hurdle,” Peterson said recently while recapping a story that has yet to find its happy ending. Because he didn’t have a fixed address anymore and had lost all of his identification, he was told he wasn’t a resident of Charles County and couldn’t qualify for assistance.
He was also told he could qualify for primary adult care insurance, but would need to wait 45 days. He needed an ID and proof of marital status, which would take another 45 days.
All of this time he was trying to get the treatment he needed to keep the hepatitis C in check along with associated problems like high blood pressure.
Now, more than half a year after being released from jail, he is still in limbo, waiting for forms to clear all while going in and out of the hospital when his disease flares up. He’s racked up more than $10,000 in hospital bills and has since found a roof over his head at Three Oaks Shelter in Lexington Park
Rebecca Bridgett, director of the Charles County Department of Social Services, said that identification is needed for medical assistance. The agency began working with the detention center this year to offer monthly orientation classes for inmates who are nearing release and to try to have the jail issue some form of photo identification for inmates who don’t otherwise have IDs.
‘‘It’s terrible, it’s really terrible,” Jean Harmon said of the situation here for the homeless. Harmon is the emergency service housing director at Three Oaks.
‘‘Quite a few of the men here have Health Share,” Harmon said.
Through Health Share of St. Mary’s, patients can sign up with primary care physicians to have ailments diagnosed for a $15 payment. If a person living at Three Oaks doesn’t have the $15, the shelter will pay for it through a special fund.
Some patients go to a local walk-in clinic or the hospital emergency room, although the idea is to avoid the emergency room and instead link people with a primary doctor for continued follow-up, said Dr. Patrick Jarboe, a co-founder of the program.
Health Share has provided support for basic health needs since 1991, including providing access to primary-care physicians and helping with prescriptions and hospital services. It now serves more than 1,000 people in St. Mary’s County each month.
Health Share, like other regional and state programs for adults, is far from full-service health insurance. Jarboe said there is care available for things like cardiac and gastrointestinal ailments as well as gynecology, but some other specialty areas do not have doctors participating.
Harmon said it is often difficult to find specialist care for the shelter’s residents. ‘‘In other words, it covers finding out what’s wrong with you but it doesn’t cover taking care of it,” she said.
Some of the men and women turn back to self-medicating their pain through alcohol or other drugs. If the pain is severe enough, it limits their abilities to find and hold jobs, too, Harmon said.
‘‘Yes, they’re going untreated,” Harmon said. ‘‘They suffer, until, you know.”
She said in other jurisdictions, including Washington, D.C., Baltimore and Prince George’s County, there is a program called ‘‘Healthcare for the Homeless” that can pay for some of the costs involved with specialists and even supply a mobile clinic. No one from St. Mary’s County has been able to write a grant application for the program, Harmon said.
One shining light in medical care for the poor is the Lions Club. ‘‘They’ve never turned a person down who needs glasses,” Harmon said.
Peterson, meanwhile, continues to struggle through the maze of paperwork, phone calls and bureaucratic red tape he has battled for months.
‘‘If someone that didn’t have people-coping skills, they could be turned away” and give up on the process, he said. ‘‘You’re at the mercy of what they tell you.”
Though Three Oaks staff members have been helpful in pointing him the right direction, he has continued to run into roadblocks with social services and other organizations set up to help those on hard times.
Perseverance, he said, is the only thing that may eventually help him.
Across the river, in Calvert County, a single mother of three said the same thing.
‘You kind of got to put your pride aside’
Thembi Edwards has worked as the administrative assistant at Healthcare Solutions since the beginning of June. Before that she had a really rough year.
She had health insurance ‘‘a long time ago.” Edwards’ last job, which she said was a good paying job with a Navy base contractor in St. Mary’s County, offered insurance, she said, but it was too expensive for her.
‘‘A series of unfortunate events happened,” she said. ‘‘My car broke down, then rent started to be late, then I found out I was pregnant,” Edwards said. She tried working at a day care center for a while but because her pregnancy was considered high risk due to her diabetes and other factors, she was put on bed rest.
‘‘We were behind the rent [at her Lusby home] and there was no catching up,” she said. She was evicted and nearly ended up homeless before she arranged to stay with friends in St. Leonard.
A single parent of three children — Micah Dyson, 7 months, Tauri Chesley, 11, and Dakota Edwards, 14 — she has relied on the Maryland Children’s Health Insurance Program, MCHIP, to cover her children’s health needs.
‘‘If it weren’t for the MCHIP, I wouldn’t be able to take my kids to the doctor when they need it,” she said. It also helps pay for physicals so her older children can play sports at school. The state medical assistance even covered having her son’s tonsils removed two years ago because it was medically necessary.
‘‘My health is very important, because my kids only have me,” she said. Edwards was covered while she was pregnant and for several months after, but soon that will end. ‘‘I’m slowly recuperating now that I’m back at work,” she said of her financial woes. She plans to enroll in Healthcare Solutions, where she recently got hired as an intake specialist.
With new guidelines about who is covered starting this year, more people can be covered.
Healthcare Solutions, a health-care assistance program in Calvert, picks up the ‘‘hole” for adults with incomes between 117 percent and 200 percent of the federal poverty index. Below that, the state can cover. Above that, hopefully people can afford their own care.
But in reality, ‘‘Even above that people have a hard time in today’s economy ... but frankly there’s not much we can do for them,” said Jon Frank, chair of the Healthcare Solutions board and owner of a private health insurance agency in Prince Frederick.
Adults who purchase health insurance on their own shell out $75 or more a month. ‘‘That covers you for worst-case scenarios, catastrophic-type coverage,” Frank said.
The group covers people 19 to 64 because those younger than that are eligible for state assistance, and those older than that can be on Medicare. ‘‘We hook them up with a doctor in the community and when they go see that doctor, they pay $15,” Frank said.
The care includes 50 percent of the cost for generic prescriptions and can cover X-rays and a first-time health assessment, which is free.
‘‘We have a number of specialists participating in our program,” and are on the look out for more to sign up, he said. The group is seeking a matching grant to expand its specialty services.
At one point, Edwards tried to get her own insurance through Blue Cross⁄Blue Shield but was denied because of her pre-existing conditions, she said.
Edwards said she, like most on state health care assistance, never wanted to rely on public help.
‘‘It’s something I had to do to survive,” she said.
‘‘Certainly, aspects of my health care get put on the back burner,” she said.
‘‘Having faced homelessness, because health care is not as important as having a roof over our head,” she has had to make some really tough choices, she said.
Still, she maintains, ‘‘The help is out there. You kind of got to put your pride aside and make those phone calls.”
Edwards has been able to find the medical assistance she needs for herself and her children, but has spent countless hours applying for the coverage and tracking down doctors and dentists who will accept the assistance.
‘‘You have to make the time,” she said.
Health care for the uninsured is ‘‘woefully inadequate” in Maryland, Frank said.
Calvert’s system is serving a little more than 100 people a year now. ‘‘We have capability to take on more people,” Frank said.
About 1,200 people in Calvert currently meet the program’s criteria and don’t have insurance.
‘‘We have all done things a little different,” he said of Southern Maryland counties’ approaches to addressing health-care issues. ‘‘Our health-care system is a huge animal,” Frank said.
The free clinic‘works really well’
Charles County has a unique model for providing health care to the uninsured. A free clinic in Waldorf addresses many of Charles County residents’ health needs.
The model ‘‘works really well,” said Tim Brown, executive director of the clinic. It allows for a one-stop shop for patients to take care of many medical needs and avoid having to use the emergency room for some issues.
‘‘A variety of health care professionals volunteer their time” at the clinic, Brown said. This includes a new dental area, which aims to provide dental care for children ages 2 to 10. The clinic hopes to expand services to all children and eventually adults as more dentists offer to volunteer their services.
The medical clinic serves those uninsured or underinsured who are below 200 percent of the federal poverty index. It has had more than 2,000 visits from about 700 patients over the last 12 months, Brown said. Of those, 527 were new to the clinic.
There is no charge for the services, even if seen by a specialist, although the clinic asks for a $2 donation from patients.
The clinic began opening its doors six days a week about a year ago as the need for the clinic grew. The three most common diagnoses are high blood pressure, high cholesterol and diabetes. All three are chronic conditions that need routine care.
The clinic was just granted access to a program that will allow retired doctors, dentists and other medical professionals to volunteer at the clinic and have malpractice insurance covered through the federal government.
‘‘We’re really excited about that,” Brown said. This protection has only been awarded to about 80 free clinics out of the roughly 2,000 in the nation.
