Maryland program covering more uninsured, despite slow start

One Maryland county's program to provide health care to moderate-income uninsured adults actually has been more successful at enrolling lower-income people in state public health coverage. But officials running the Healthy Howard Access Plan are not disappointed.

The plan is an effort to connect uninsured adults earning 300% of the federal poverty level or less with an array of health care available in or near Howard County, located west of Baltimore. Only about 250 people -- fewer than initially expected -- have either signed up for Healthy Howard or are in the application process as of mid-February, said Howard County Health Officer Peter Beilenson, MD, MPH. Still, that pace puts the program on target for a goal to enroll 2,000 adults in 2009, he said. Enrollees began receiving care in January.

The program charges a monthly fee of at least $50 in exchange for medical and dental care plus discounted prescription drugs. Healthy Howard is similar to a San Francisco program in that it's not health insurance but is instead a local safety net for people without access to coverage. The Howard County program differs in that it relies more on grants and donated care than the San Francisco effort and does not tax businesses that don't provide health coverage.

"Our goal is that a significant number of [Healthy Howard] participants will never need to set foot in the hospital emergency room, not only saving all of us money, but freeing up the resources of the hospital for true emergencies," said Howard County Executive Ken Ulman.

Dr. Beilenson said Healthy Howard is benefiting from a significant amount of charity care. About 200 physicians in 18 practices in a wide variety of specialties have agreed to provide free care to program enrollees. Three area hospitals also have agreed to participate.

Finding uninsured people in the county has not been difficult. More than 1,100 adults without insurance turned up last October during an eight-day Healthy Howard enrollment drive, but only 50 qualified. About 750 others were eligible for Medicaid, the Children's Health Insurance Program or a Maryland program that offers coverage to uninsured low-income adults. Another 300 received coverage through Kaiser Permanente's Bridge program, which offers three years of nearly free health insurance to people earning 250% of poverty or less.

Some of the uninsured people might not have known that Maryland increased Medicaid eligibility in July 2008, said John M. Colmers, secretary of the Maryland Dept. of Health and Mental Hygiene.

More efforts could help Healthy Howard reach its enrollment goal. The county is waiving the requirement that applicants be uninsured for six months for people who have lost jobs, Dr. Beilenson said. The county also plans to offer finders' fees of $20 to $25 to people or organizations who find uninsured people who complete the Healthy Howard enrollment process.

"That would encourage community organizations who are already seeing vulnerable populations for food stamps or for day care to say, 'Hey, go online and try out the easy [eligibility] screening tool,' " Dr. Beilenson said.

Healthy Howard caught the attention of U.S. Sen. Barbara Mikulski (D, Md.), who on Feb. 17 chaired a Senate Health, Education, Labor and Pensions Committee field hearing on the program at Howard County Community College.

Roughly 20 of the 250 Healthy Howard enrollees have visited Chase Brexton Health Services' Columbia office, the federally qualified health center serving as the program's primary care medical home, said Kari Alperovitz-Bichell, MD, the site clinical director. A few dozen others have scheduled appointments. The health center is paid for treating Healthy Howard patients. Many enrollees probably wouldn't come to the clinic outside of the program because most earn too much to qualify for significant discounts, she said.

Partnering with the county to care for low- to moderate-income people makes sense because the Columbia health center's four family physicians are likely more knowledgeable about the health care safety net than the average private physician in an area as wealthy as Howard County, Dr. Alperovitz-Bichell said. "I have the Wal-Mart $4 [generic drug] list memorized."

She isn't sure how viable Healthy Howard will be because it relies on donated specialty care. But the program is terrific for the people the clinic can serve, she said. "It's part of what needs to be done."

Representatives from other Maryland counties have contacted Dr. Beilenson about Healthy Howard, but they generally conclude the program requires a lot of work. "Mostly it's a wait-and-see attitude."