D.C. low-income, undocumented dialysis patients had feared losing insurance coverage


Dialysis patient Bizunesh Ayitenfisu, 58, of Ethiopia, left, and her husband, Getahun Gebre, 60, are pictured in the waiting room of the Capital Dialysis Center. (Sarah L. Voisin/The Washington Post)
September 27, 2013

Three times a week, Valeriano Bonilla and Bizunesh Ayitenfisu report to a clinic in Northeast Washington, where they are hooked up to machines that filter toxic blood from their failing kidneys. After four hours, they have gained a few more days of respite from swelling limbs, difficult breathing and other symptoms that — if they miss one or two sessions — can lead to a fatal collapse.

Like many other low-income or undocumented immigrants in the District, these patients with chronic conditions do not qualify for Medicaid. Instead, under a program called the DC Healthcare Alliance , a series of low-cost insurance providers have paid for the dialysis treatments, which can cost up to $3,700 a month.

But last week, this safety net appeared about to collapse, sending foreign-born dialysis patients and their doctors into a panic. Medstar Family Choice, the insurer that covers most Alliance patients, announced on its Web site that after Oct. 6, it would no longer pay for outpatient dialysis.

The site advised patients to fill out a form and apply for Emergency Medicaid, or to call three phone numbers for information. Later, Medstar officials said there was no need for alarm and that dialysis soon would be fully covered again. But Bonilla and Ayitenfisu, who speak no English, only knew something was wrong.

“Without this treatment, I cannot live. This means life to me,” said Bonilla, 71, a native of El Salvador whose only support comes from the $350 weekly pay his son earns working in a restaurant. Asked what he would do if he lost his insurance, he shrugged and frowned. “I would have to give up and die,” he said.

Jay Ocuin, a doctor who operates the Capital Dialysis Center, said he would continue to treat Bonilla, Ayitenfisu and 14 other Alliance patients even if their insurance is cut off. He said that applying for Emergency Medicaid or other insurance is cumbersome and that Medstar did not give patients enough warning.

“These are our patients, and there is no way we can abandon them. They have no way to fend for themselves,” he said.

But Medstar officials said the panic was baseless and that the confusion was a result of changes in insurance rates and Medicaid contracts with the D.C. government. They said that as soon as the fiscal year begins later this fall, outpatient dialysis would be fully covered again under the regular Alliance program.

Officials of the District’s health-care finance agency offered a similar explanation and said that after Nov 1., dialysis would be covered for all Alliance patients as a part of their regular managed care. Meanwhile, they said, there would be no harm to patients — only extra red tape for clinic officials to file claims for emergency treatment.

“They don’t like it, and I don’t blame them, since it is a bit more difficult to bill for a medical emergency for a noncitizen than just to bill your health plan,” said Wayne Turnage, the agency’s director. “But patients will be covered.”

Meanwhile, worry and rumors continued to swirl at District health clinics. Some officials speculated that the D.C. government, because of its precarious financial situation, had decided to simply cut dialysis from the services provided to Alliance clients.

The Alliance is open to all uninsured and impoverished D.C. residents, but most native-born low-income patients are eligible for regular Medicaid. As a result, a majority of Alliance members are immigrants, including some who are illegal.

The flurry of concern was also a reflection of the troubled history of health insurance coverage for low-income D.C. residents. Last year, Chartered Health Plan, the city’s long-term Medicaid contract insurer, collapsed after failing to pay millions of dollars in claims. Since then, three other companies have been involved in insuring Alliance patients.

Pamela Constable covers immigration issues and immigrant communities. A former foreign correspondent for the Post based in Kabul and New Delhi, she also reports periodically from Afghanistan and other trouble spots overseas.
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