Health care waiver covers fewer uninsured patients than earlier ...

Although there are about 80,000 low-income adults in the New Orleans area without health insurance who should be eligible for a program that provides primary care benefits, only about 53,500 people have enrolled. Clinic leaders across the region credit the so-called Greater New Orleans Community Health Connection with helping them provide necessary primary care for people who would otherwise be uninsured.

But there is no doubt that fewer people are being helped by the current program than were being taken care of by an earlier $100 million federal grant.

Dr. Karen DeSalvo, the New Orleans health commissioner, said the infusion of federal money helped local clinic leaders rapidly expand their operations in the years after Hurricane Katrina, when the services provided by the LSU public hospital system were limited. DeSalvo said the clinics tried to emphasize quality, for example, setting up a system of clinics with connected electronic medical records.

?Clinics went from urgent care stations to having recognition as high-quality primary care medical homes,? she said.

The grant was also more flexible than the GNOCHC waiver that replaced it in 2010. The new three-year, $97.5 million program came with many of the restrictions of the federal Medicaid program. This meant that fewer people have gotten coverage under the waiver, DeSalvo said.

For example, while the grant paid clinics to treat patients who couldn?t prove they are U.S. citizens, that isn?t the case under the waiver in place now. Additionally, clinics ended up treating a small portion of patients who lived outside the four-parish area under the grant, something that isn?t allowed under the waiver, DeSalvo said.

However, these differences don?t explain why more than 26,000 people who should be eligible for GNOCHC coverage haven?t signed up for benefits. Several clinic leaders said they aren?t quite sure why more uninsured people haven?t gotten coverage.

But they noted that many of their uninsured patients haven?t qualified. Michael Griffin, president of the Daughters of Charity health centers, said only about 50 percent of the clinic?s uninsured population has qualified, less than originally anticipated.

Despite those hiccups, the program must be considered a success, Griffin said. He noted that the state and federal government agreed to divvy up any money left over from the annual $30 million pot at the end of the year between participating clinics, which helps them make ends meet.

Bethany Bultman with the New Orleans? Musicians Clinic said only 400 of the center?s 2,400 patients ended up being covered under the waiver. Although the clinic helps patients fill out the application, Bultman said the clinic isn?t notified if the person is rejected.

Many musicians operate within a cash-based economy. Some don?t pay taxes, Bultman noted. Without required paperwork, they can?t prove they fall within the program?s income restriction of families who make no more than 200 percent of poverty.

For Bultman, it?s been very frustrating. Under the original grant, Bultman said her clinic ramped up care, making sure the musicians and others who frequent her clinic received comprehensive care.

?It meant that everybody that came in would get diagnosed much earlier for chronic conditions,? she said. ?I felt like we changed a health care pattern.?

Bultman said she keeps the clinic afloat by soliciting money from people who want to support New Orleans musicians.

Pam Holm, director of primary care for the NO/AIDS Task Force, reported her clinic had a better experience with the GNOCHC waiver. At one point, about 30 to 35 percent of clinic patients, who are all HIV positive, were enrolled in the program.

?I think it?s been fairly successful,? she said.

More recently, the clinic has begun to rely less on the GNOCHC program by shifting patients to other insurance programs made available through the federal health overhaul.

The law created a federal insurance plan for people with pre-existing conditions, like HIV, and the clinic has been able to hook patients up with federal funds that pay their premiums and deductibles, Holm said. Those funds are also restricted to lower income people with HIV.

Source: http://www.nola.com/health/index.ssf/2012/11/health_care_waiver_covers_fewe.html

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