Uninsured Discover They Had Coverage
New Program Helps Howard Spot Gaps

By Lori Aratani
Washington Post Staff Writer
Friday, November 28, 2008

Howard County's groundbreaking program that offers low-cost health care to uninsured residents has succeeded in securing care for nearly 1,000 people. The catch? The vast majority already qualified for existing programs and won't be part of the Healthy Howard initiative.

Instead, the county is enrolling these residents in other state, federal and nonprofit programs they didn't realize they were eligible for. The disconnect, county officials say, points to troubling gaps not just locally but also across the nation in matching critical services with those who need them.

"This is a tremendous indictment of how badly the health-care system is set up," said Howard County Health Officer Peter Beilenson. "These people have been going without health insurance, yet they were eligible for an existing program all along."

Nationally, one of four non-elderly uninsured people in 2006 -- or about 12 million -- were eligible for public health insurance programs but were not enrolled, according to a study done this year by the National Institute for Health Care Management, a D.C.-based nonprofit group underwritten partly by insurers.

In Virginia, where about 8.8 percent of children don't have coverage, health department officials estimate that 96,000 children could qualify for a publicly funded health insurance program. The challenge is to find them, officials say.

In Howard, about 850 of 1,100 people who attended information sessions for the county initiative have been directed to other programs that can offer them medical care or insurance. By contrast, 44 people have enrolled in Howard's program, which can provide basic medical care for a small monthly premium for as many as 2,200 people.

Julie Schoenman, director of research and development for the nonprofit group that conducted the national study, said the reasons people don't have coverage run the gamut. Sometimes, as Howard officials are finding, people aren't aware they can qualify. More often, they find the paperwork too daunting and give up without enrolling, she said. For some, there is also the stigma associated with seeking public assistance, she said.

Brad Herring, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said officials need to do a better job of translating bureaucratic terms into language people can understand.

"Many people just don't realize whether they're eligible in large part because eligibility is based on a fraction of the poverty line. People don't always know where they are relative to the poverty line."

Maryland began an outreach initiative this year through the state comptroller's office based on a pilot project that began in Howard. The comptroller now uses income-tax data to zero in on families eligible for state health-care programs and send them letters. A fifth batch of letters recently went out.

In the District, officials have partnered with churches to help reach eligible populations. They have also revamped the application process to create a "one-stop" application that screens people's eligibility for a number of programs, including food stamps and health care, said LaShon Beamon, spokeswoman for the D.C. Department of Health Care Finance.

"This is a challenge that confronts all states," said John M. Colmers, secretary of Maryland's Department of Health and Mental Hygiene. "We have done a very good job of reaching out to people, but there remain people who by definition are facing lots of challenges in life, who are not taking advantage" of programs.

Some states are employing new technology to reach eligible people, said Barbara Lyons, vice president of the Kaiser Family Foundation, which recently released a study about the use of such technology.

Howard officials have been able to flag a person's eligibility for other coverage programs because they are using a one-stop electronic system that automatically sorts through available programs and determines the proper one for each person. Colmers refers to it as "Turbo Tax" for health insurance enrollment.

Howard officials would like to have enrolled more people in their program but say the important thing is that more people now have health care.

"Our goal has been affordable, comprehensive health coverage," Beilenson said. "If people can get that through other avenues, that's a positive."

Howard residents without insurance can sign up for the program, which will provide as many as six visits a year to primary-care doctors, free in-patient hospital care, mental health care, discount prescriptions and other services that would probably cost thousands of dollars if they had to pay out of pocket. Women will also be provided an additional OB/GYN visit.

Beilenson said it is too early to know what these early enrollment numbers might mean for the future of the Healthy Howard initiative. He said county officials plan to revamp their recruitment efforts. Next month, they'll do outreach at Howard County Community College and work more closely with the small-business community, two populations that are sometimes overlooked but might be ideal for what Healthy Howard offers.

They'll offer on-site enrollment wherever they do their presentations. Beilenson said he thinks they'll have at least 100 people signed up by Jan. 1, when enrollees can begin receiving care.

"Let's not lose sight of the fact that [more people] are going to have coverage," he said. "Our only issue is more specific recruitment for Healthy Howard."