Health Plan To Be Based On Monthly Fee System

For a monthly fee as low as $50, working-poor residents of Howard County would get access to health services ranging from immunizations and checkups to mental health and hospital care under a plan that county officials say could provide a template for jurisdictions across the nation.

At a news conference yesterday, county officials said they hope the plan, expected to be phased in over several years, will bring good health care to the county's uninsured residents, estimated to be at least 20,000 children and adults.

"We believe it is unacceptable that 20,000 residents do not have health care," said County Executive Ken Ulman (D).

The problem is shared by counties across the country that are struggling to find ways to provide care to 47 million uninsured Americans.

"We're filling the gaps left by the federal system," Ulman said. "In the absence of a national solution, it is time for local jurisdictions like Howard County to step up to the plate."

The plan is designed to employ a network of public and private resources to provide services to needy residents in the third-richest large county in the nation.

The Healthy Howard program, which is not an insurance plan and is not portable outside the county, is designed to be available to adults who have been living legally in the county for a year or more, have been uninsured for at least a year, are not eligible for state or federal health-care plans and meet income requirements, county health officer Peter Beilenson said.

The program, scheduled to get underway in July, is expected to enroll 2,000 adults in the first year. Officials will work to channel other uninsured residents into government-funded programs for which they might qualify. Many of the county's uninsured children are eligible for but are not enrolled in Medicaid or the State Children's Health Insurance Program.

"The more who can be covered by federal and state, the less have to be covered on a local level," Ulman said.

Initially, the bulk of routine services are be provided by Columbia's Chase Brexton Health Services, a community health center that sees about 800 uninsured patients on a sliding fee scale, and the nonprofit Howard County General Hospital. Officials are also building a network of private providers to work with the plan.

Half of the expense of the program, expected to cost $2.8 million in its first year, is to be covered by monthly fees paid by enrollees. The remaining half is expected to include $500,000 in county general funds and donations from foundations, philanthropies and individuals.

The fees are to range from $50 a month for a single enrollee with a family income at or below 200 percent of the federal poverty level (about $41,000 for a family of four) to $115 per month for a couple with a family income up to 300 percent of the federal poverty level.

The fee will entitle each enrollee to services that include at least six doctor visits per year at the community health center, hospital care at Howard County General and mental health, substance abuse and diagnostic services. Prescriptions will be offered for $10 each, not to exceed $20 per month. The program does not include dental care.

Each enrollee will be required to meet with a health coach who will map out a wellness plan, which the participant is responsible for following. Noncompliance can be grounds for dismissal.

"We feel access to health care is a right, but it's also a responsibility," Beilenson said.

The program won't cover undocumented residents, although county officials estimate that several thousand rely on medical services for emergencies.