As Obamacare starts, patients in Maryland community clinics are eager to sign up


Navigator Rebecca Wener, left, speaks to Maria Martinez, 44, of Rockville. At Community Clinic Inc., a group of navigators and in-person assistants were present to reach out to the uninsured community and explain the Affordable Care Act. (Sarah L. Voisin/The Washington Post)
October 1, 2013

The day Maryland’s health insurance exchange opened for business was Rebecca Wener’s first day of work. She sat down next to Maria Martinez on Tuesday in the waiting room of a Silver Spring clinic and started gently asking questions in Spanish.

Do you have health insurance? Wener asked. No, replied Martinez, 44, of Rockville. She works two part-time jobs — in customer service at Balducci’s, a gourmet food store, and cleaning houses. Do you know that many new options are available to you under health reform? No, Martinez said. She knew that a law had been passed and that everyone had to have insurance, but not much more than that.

Wener explained that Martinez might be eligible for Medicaid or perhaps financial aid to help pay for private insurance. Martinez listened intently. Yes, she nodded, she wanted to set up a meeting to get details. Esta bien. She wrote down her name and cellphone number for Wener. Jueves, she said. En la mañana. Thursday morning for the next appointment.

Wener, 26, is one of more than 300 “navigators” and other consumer guides working across Maryland to find people who are uninsured, help them figure out their options and, if they are ready, sign them up online or with a paper application. Specially trained to provide in-person help, these navigators are considered critical to the outreach and enrollment effort.

Community Clinic Inc., a private nonprofit group that serves about 50,000 low-income residents at seven locations in Montgomery and Prince George’s counties, deployed six consumer guides to its facilities Tuesday. They weren’t sure what to expect; they had been told during their training that there were likely to be technology glitches.

Sure enough, early Tuesday morning, navigator Apoorva Srivastawa, 24, ran into a big one when she opened her laptop and tried to log on to the Maryland Web site at the Silver Spring clinic. The portal was down. It wouldn’t be available until noon. And throughout the rest of the day, the high volume of traffic made it virtually impossible for navigators to work online, according to Wendy Korrick, CCI’s outreach and enrollment director.

The Silver Spring clinic is usually relatively quiet on Tuesday mornings; fewer patients are scheduled for that day because clinic directors hold an administrative meeting. But at the nonprofit’s other locations in Takoma Park, Gaithersburg and Greenbelt, waiting rooms were full of patients eager to learn more about their health insurance options. Without access to the Web site, navigators started using paper applications. By late afternoon, at least seven applications in total had been started from those three locations, Korrick said. At least a dozen more people had scheduled a return trip to complete the process, navigators said.

The response has been “pretty significant,” Korrick said. “People are eager to learn. A lot of people have scheduled an appointment.”

Martinez was one of them. Wener told her to bring a picture ID and, if possible, proof of income and residency. The Rockville resident can buy insurance from Balducci’s, but it costs $70 a week, Martinez said — “It’s expensive.”

She earns $21,000 to $22,000 a year. A few years ago, she had to go to the emergency room at Holy Cross Hospital in Silver Spring for back problems. She couldn’t afford the $600 bill but was able to get financial assistance from the hospital to cover it.

Martinez said she wants to get insurance now. “You just never know,” she said in Spanish.

At CCI’s clinic in Greenbelt, Che Sayles, 38, was the consumer helper, known as an “assister,” who spent his morning talking with two men and two women whose incomes appeared to make them eligible for the state’s expanded Medicaid coverage. He signed up one person for Medicaid, and provided information or set up return appointments for the others. The recently opened clinic draws from low- and moderate-income communities in Prince George’s County. At least 10 percent of the county’s nearly 1 million residents lack health insurance and have limited access to primary medical care.

For many Prince George’s residents, Sayles will be the first person they have ever spoken with about obtaining health insurance. He collects basic information and can contact the customer call center associated with the health exchange. And he can refer the person to a navigator, such as Wener or Srivastawa.

Sayles, a political science graduate of Howard University, said he was excited to watch a new government program launch close-up.

“I want to be able to help make a difference,” he said.

A few miles away, at CCI’s Takoma Park clinic, a navigator-and-assister duo spoke with more than 30 people who had appointments Tuesday. Many arrived at the sun-filled second-floor waiting room with young children in tow. They listened as Leidy Rambarde, 27, handed out brochures and explained the basics of the health insurance exchange.

One woman who arrived with her child didn’t need to hear any explanations.

“She came in, and she knew what she needed to show us to sign up,” said navigator Alexandra Dixon, 31. The woman brought all her documents: her driver’s license, her Social Security card, even her income tax return.

“She came straight in to apply today,” Dixon said.

Because the woman arrived mid-morning, Dixon was not able to enroll her using the online system. So they spent about 30 minutes filling out a paper application. Dixon still needs to get some income information from the woman to complete the process.

The potential enrollees didn’t seem to mind that there was no online access or that the paper applications were harder to understand because they were not in Spanish.

“She was very happy,” Dixon said.

Navigators said they were buoyed by the eagerness and receptiveness they found.

“We’re very excited,” Wener said. “It’s cool. We really came in expecting everything to go off the rails.”

Miranda Spivack contributed to this report.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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