“INSURING THE UNINSURED”A Medical Student Run Project in a Medical Student Run Free Clinic

for Improving Access to Care in an Urban Minority

Buffalo, NY Neighborhood

Michelle Niescierenko MD

University at Buffalo School of Medicine and Biomedical Sciences

National Efforts to EnsureMedicaid

•Insures people at or below 133% of federal poverty level

State Health Plans

•States have the option to supplement for incomes greater than 133%

State Child Health Insurance Program (SCHIP)

•Created by the balanced budget act of 1997•Covers children in families at or below 200% of the federal poverty level•States can supplement for incomes greater than 200%

46 million uninsured (estimate as of early 2006),

•1 in 7 or 14.6 % of the population•8 out of ten are in working families •8.5 million uninsured are children

24 million uninsured work

•19 million uninsured work full-time •5 million uninsured work part-time

A non-employer sponsored health plan would cost an average uninsured single adult approximately 25% of

their annual household income.

Why are there still so many uninsured?

• 30% of low income adults eligible are uninsured• 24% of eligible children remain uninsured

Education is the #1 reason for remaining uninsured

•Unaware of availability of these programs

•Education/Reading level too low to comprehend and complete application

What Can Be Done? Lighthouse Insurance Initiative (LII)

• Founded October 2003

• 4 Medical student coordinators and 30 medical student and undergraduate volunteers

• Enroll in Medicaid, NYS Child Health Plus (CHP) and NYS Family Health Plus (FHP)

Problems before we started

• Access to people who would be likely to qualify

• Environment suitable for multiple contacts

• Facilitated Enroller (FE)

• Trust

The Lighthouse Free Medical Clinic

• Medical student run founded in 2001 supervised by Dr. Chester Fox.

• Open Weds from 6pm on• Provides screening, triage and basic primary care• Over 2500 patients seen since opening. 12-30

patients seen per night• Volunteer FE from Erie County Managed Care

organization one night per month

The Application Process

1. Screening

2. Eligibility

3. Application

4. Documentation & Facilitated Enroller

5. Follow up

Screening

• Check in: patient’s insurance status is determined

• Uninsured patients are approached for screening.

• Screening:• Age of applicant and any children• Employment status • Number in household and family income• Is insurance available from employment source

Eligible Applicants

• Less than age 65• Income:

• Medicaid = below 133% FPL• FHP = below 165% FPL• CHP = below 200% FPL

• Resources below household limit• Not covered under any other program

(disability etc.)

The Application

• General form

• Second Signature form

• Tobacco, alcohol, and drug screening

• Information authorization

• Absent spouse/parent form

• Maintenance form

• Financial status form

Documentation

• Birth Certificate• Posted Envelope• Social Security Card• 1 Month Pay Stubs

• Childcare Receipts• Proof of Pregnancy• Proof of marriage• Tuition Bills

Application and all supporting documentation must be complete before meeting with the facilitated enroller to complete application.

Follow Up

• Patients are phoned the Monday before the FE will be at the clinic.

• Patients receive reminder phone calls for up to three months after filling out application.

• Once application is complete phone call is made to determine acceptance.

Evaluation of the LII after one year

• 579 patients seen, 319 (55%) uninsured • 281 (88%) of uninsured screened for eligibility• 52 (16%) were repeat screens on repeat visits• 224 (70%) uninsured individual patients screened • 90% African-American, 9% Caucasian, 1% other

• Insurance eligibility• 26% eligible• 53% not eligible• 11% insurance pending through other source• 10% not interested in screening

Reason for Insurance Ineligibility (out of 118 applications)

3%

2%1%

3%

7%

39%

45%

Unaccompanied Minor

Income too high

No income

Have Medicare

From out of the area

On Disability

Not a citizen

Eligible Patients

• 57 out of 59 qualifying patients filled out application packets.

• 54% women, 46% men• 2 declined to fill out application because they didn’t want

didn’t have time.

• 23 out of 57 (40%) completed applications with documentation and were accepted for a total of 33 insured patients.

• 33 out of 224 (15%) of individual uninsured patients were enrolled in permanent health insurance.

Conclusions

• The majority of our ineligible population has an income above qualifying levels reflecting the national statistic for ineligibility.

• A portion of patients using free clinics are eligible for free government sponsored health insurance programs.

• Medical and undergraduate students are a good resources for increasing the screening potential of clinics.

Where do we go from here to improve the success of the LII?

• Applicants lost to follow up• Phone disconnected• Not interested• Job changes affecting eligibility

• Single encounter with the applicant.

• Increase screening to 100%

• Advertise

Buffalo Civic Empowerment Award