By Regina Dennis, Waco Tribune-Herald, Texas

Feb. 5–Faced with an increasing number of applicants seeking indigent or discounted health care, the county soon will begin a new partnership with the Family Health Center that will make access to coverage easier for residents.

The McLennan County Health Services Department currently has 317 active clients on the county’s indigent health care program.

That is 24 percent more than the 255 clients served in December and the highest number of clients that have been on the program at one time, health services director Eva Cruz said.

A health district claims case worker will be placed at the Family Health Center full-time to process indigent health care applications.

A health district claims case worker will be placed at the Family Health Center full-time to process indigent health care applications.

“It concerns me that it may keep going up and up, but I don’t know if it’s just because it’s wintertime and a lot of flu and illnesses are going around or if it’s that more people who are unemployed, but it does concern me,” Cruz said. “It’s too early to tell where it’s coming from, why we are having such an increase.”

Cruz said while the jump could be from people who applied for the program in the fall and were waiting to be approved, she expects that the number will go up as more residents grapple with health care costs.

In November, the health services department saw 360 clients seeking care through the indigent health program.

That number rose to 471 in January, a 31 percent increase.

Cruz said though some people are applying for the indigent health care program, others come to the office to be screened for the Good Health Card program. The card is administered by the Family Health Center and offers enrollees discounted health care services at Family Health facilities based on income.

The programs create a safety net of health care coverage for the county’s uninsured.

Cruz said to better serve clients, the health district soon will place one of its four claims caseworkers full time at the Family Health Center’s main office, at 1600 Providence Drive, to process indigent health care applications.

The move also may lower the district’s no-show rate of clients who miss scheduled appointments, an almost daily occurrence at the health district, she said.

“It could be that there are people who don’t have a car or have to wait and get somebody to bring them to their appointments, and they may not always have a ride,” Cruz said.

Allen Patterson, chief financial and operating officer for the Family Health Center, said creating this link between the two offices will allow residents easier access to both programs and likely bring more qualified residents to the indigent health care program.

“We can give them the Good Health Card program here, they can qualify for that here on our site, but they always have to make a separate trip to the county to get evaluated for the indigent health care program,” Patterson said. “In terms of how many people we refer over to the county that actually go there to get evaluated, very few, frankly.”

Qualifying residents To qualify for indigent health care, income must not exceed 21 percent of the federal poverty limit based on household size, which is about $2,274 annually for an individual and $4,630 for a family of four. The county pays for all services under the program, including office visits, lab and X-rays, prescriptions, and inpatient and outpatient hospital services.

For the Good Health Card program, income criteria is up to 200 percent of the federal poverty limit. That is $21,660 for an individual and $44,100 for a family of four.

Enrollees receive a 50 to 80 percent discount on medical services at the Family Health Center based on their income.

Patterson said the number of clients using the Good Health Card at the center also is steadily increasing, peaking at 6,000 for 2009.

“In the last year, our economy being what it has been, there is no question that we have lots more folks coming to see us that have lost their insurance coverage, in most cases because they have lost their jobs and not able to afford COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage,” Patterson said. “We’re there for everybody that needs us.”

Need for health care Cruz said Family Health estimates that it would refer about 50 people each week to the county caseworker to apply for indigent health care.

One such example is Bellmead couple Gene and Robin Mackley, both Good Health Card members who went to the health services office Monday to see if they could enroll in indigent health care.

Gene Mackley, a painter, injured his back Jan. 11 after bending over to pick up something.

He was taken by ambulance to Hillcrest Baptist Medical Center, where an MRI showed he had a protruding bone in his back — a diagnosis that wracked up thousands in emergency medical bills.

The injury also means no income for the Bellmead couple, who also are raising Robin Mackley’s 10-year-old nephew. Gene Mackley, 44, was making about $440 per week when he had a painting gig and would do odd jobs in between work assignments to support the family.

“I was like, ‘You’re our bread and butter, now what do we do?’ ” said Robin Mackley, who has been unemployed since August and has been unable to find a new job.

Robin Mackley said the couple had been on Good Health Card program for a year, but the card expired in November.

She reapplied for the card in January after her husband was injured. However, she was granted only one month of service, instead of the traditional six-month usage period, until the couple’s income could be verified.

Family Health referred Gene Mackley to a neurologist, but without insurance, the initial visit fee is $450 upfront. The couple have only $120 in their bank account, and Robin Mackley said she has had to turn to agencies like Caritas for grocery help.

The couple have a return appointment at the health services department Feb. 8 to see if they were approved for indigent health care.

“I don’t know if this is going to work out or how it is going to work out, but I’m hoping that we can get some help, because we need it,” Robin Mackley said.

Cruz said it’s not uncommon for caseworkers to encounter tales of financial woes from clients. But fewer than 2,000 of the county’s estimated 230,000 residents meet the income requirements for indigent health care.

“Even if there are people who don’t qualify for the indigent health care program, my goal is that people who have health care needs can feel that they can come here for help, and we can do what we can to see what resources and aid are available to get them the coverage they need,” Cruz said.

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