“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 Ensure Medicaid 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 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 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

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