Each time one of Milton Armstrong's three children would get a bump, bruise or cough, he would hold his breath, hoping it wouldn't mean a trip to the hospital. Without health insurance for his family, he knew a minor injury could mean a major expense.
So when he heard about the D.C. Healthy Families Program during a church health fair, he said his prayers were answered.
"Kids are always falling down, getting bruises or scraping something, so not having insurance was a real headache," he said. "We didn't have a health plan for four years. I tried to shop around, but some [carriers] wanted $400 a month. With me trying to maintain my household and pay a mortgage, it would be kind of difficult."
D.C. Healthy Families, a Medicaid expansion program funded by the D.C. and federal governments, provides free health insurance for low- to moderate-income families living in the District. Children living at or below 200 percent of the federal poverty level, as well as their parents or legal guardians, are entitled to full medical and dental coverage, including vision care and prescription medicines. Pregnant women or independent persons under 19 may qualify as well.
The D.C. Department of Health estimates that there are 81,000 uninsured people in the District, including 15,000 children. The D.C. Healthy Families program was started in response to those staggering statistics.
Participants may select one of the seven Medicaid Managed Care organizations for primary treatment. Those eligible for the program may be entitled to full Medicaid benefits as well.
Lynda Flowers, a Medicaid policy analyst with the D.C. Department of Health, said it was important that the program be tailored to accommodate not only the poorest families but those of moderate income as well.
"We started with the backbone of Medicaid and state and federal set benefit package standards [as a guideline], but we raised the income ceiling so that low- to-moderate-income working people can have access to affordable health care as well," she said. "So a family of four can make $32,900 and still get their kids in this program. In the old days, it would be half that, so you would have to be poorer to get that type of help."
Flowers said the program also aims to reach families who recently have gone from welfare to work and for whom paying for health care can be a heavy strain.
"We try to help families from welfare to work by allowing them to get a job without worrying about not having health care. It can be difficult for a family just off welfare if they are unsure of how they are going to get health care," she said. "One setback, [such as] a father having a heart attack, could be financially devastating and force them back on welfare."
Armstrong, 45, said the program relieved the burden he carried of trying to eke out extra money for medical care. He said he takes comfort in knowing his family's health coverage is provided for.
"I think it is really great that a program is out there to help families with health insurance. In this country, paying for health care is a huge problem for many families--families with no options."
The program stresses preventive care. Flowers said that far too often families don't get the ongoing care they need to prevent more serious and costly illnesses.
"We are so happy to be able to give families access to not only treatment but preventative care, where a woman can go in for her Pap smear or a father to get his prostate checked," she said. "Without the program, they would have to wait in long lines in emergency rooms after their conditions have worsened--conditions that could have been prevented."
The need for regular checkups drew Alma Newsome to the program. Newsome, 56, said she always made sure her seven children got the medical attention they needed. But when her husband died three years ago, she and her 14-year-old son, Daniel, lost their health insurance. With her husband's Social Security as her source of income and with no health insurance, Newsome said she would have to forgo regular checkups herself and rely on her older children to pay for Daniel's doctor's visits if she were not in the program.
"I wanted to get some kind of insurance, but it was so expensive. Before the program, I hadn't been to the doctor in a long time. And whenever I needed to, I had to go to the emergency room," she said. "I would be feeling bad, knowing that I needed to go to a doctor, but I wouldn't. I would just take some over-the-counter medicine and pray that it worked."
D.C. Healthy Families has an information line, 1-800-MOM-BABY (800-666-2229).
CAPTION: At the Family Health Center on Minnesota Avenue NE, Milton Armstrong and his wife, Karen, discuss some lab tests with their physician, Joshua Holloway.