Impoverished Pinellas County residents soon will get better access to preventive health care and a doctor they can call their own, thanks to creative thinking by government and health care officials and a cooperative approach that transcended bureaucracy and traditional territorial boundaries. However, as is so often the case with health care for the poor, budget shortfalls could slap a lid on the number of people who can be served, no matter how desperate their need.
For six years Pinellas County contracted with WellCare Health Plans Inc. of Tampa, a private managed-care company, to handle delivery of medical care to the county's poor. But too many of the clients showed up at hospital emergency rooms with advanced illnesses — no surprise, since the WellCare program did not emphasize preventive care. Expensive treatments for those advanced illnesses contributed to steadily rising costs for indigent care, not only for the county, but also for hospitals. The county and its Health and Human Services Department, forced to cut their budgets, had to find another, cheaper way to go.
The option they chose, after months of study and negotiation by local public health experts, was to cobble together a network of clinics that would provide a "medical home" for regular checkups, immunizations and the like for adults ages 18 to 64 who have no money, no insurance, and no access regular medical care. The program will use existing medical facilities: three state-operated Pinellas County Health Department locations, and the five clinics operated by nonprofit Community Health Centers of Pinellas Inc. Officials say doctors and nurses will be added at those locations, if necessary, to serve the new clients. A case manager also will be provided to ensure clients get their medical needs met.
Officials have only a vague idea of how many people may meet the program's qualifications — perhaps 15,000 to 20,000 people, they say, though given the sour economy, that number likely is growing. To qualify, people must be at or below the federal poverty level, which is $10,400 a year for a single person or $21,200 for a family of four. Under the WellCare contract, which will expire in September as the new program comes online, people who met the poverty guideline could not participate if they had more than $2,000 in assets. That asset cap is being removed for the new program, so more people — still obviously in dire need — may qualify.
County officials hope that the emphasis on preventive care and early treatment of minor illnesses will reduce program costs from $27-million this year to $22-million next year. Of course, such savings will only be realized if the number of enrollees does not swell because of the economy, and if clients do not have to wait so long for appointments that they get frustrated and head to the emergency room instead.
County commissioners should ask for regular reports on the number of clients served, how long they waited for an appointment, and how many required more extensive treatments. With less money earmarked for indigent care next year than this year, it is also important for commissioners to keep tabs on how quickly the funding is exhausted. A "medical home" for the poor is a great idea, but it is an empty promise if they get turned away at the door.