WV Health Right, West Virginia’s largest free medical clinic, has seen some changes since it began accepting Medicare and Medicaid patients with the rollout of the Affordable Care Act, but the mission of the agency hasn’t changed — and won’t, its director said.
“We saw it as our duty to our current patients who were covered by the Affordable Care Act to jump into the Medicaid and Medicare arenas, as both are underserved areas,” Angela Settle, Health Right’s executive director, said. “We’re still staying true to our mission; we’re a free and charitable clinic now.”
Health Right started by signing up existing patients who were eligible for the two federal insurance programs. The clinic now accepts patients who earn up to 250 percent of the federal poverty level — $29,175 for an individual — as long as they are uninsured or are insured through Medicare or Medicaid.
Despite accepting Medicare and Medicaid and therefore billing for them, Settle doesn’t anticipate the agency will bring in any more money because it has lost part of a state grant subsidizing free clinics. Settle hopes the reimbursement rate the clinic gets for both programs will help mitigate the loss in state funding and, more importantly, provide access for newly enrolled patients who may not have coverage otherwise.
“We know firsthand from our experiences here that just because people become insured through the ACA, that doesn’t mean they have access to health-care services,” she said. “Especially in our state, there is a shortage of providers, and not only that, but a shortage of providers willing to accept Medicaid and Medicare.”
Medicare and Medicaid pay hospitals and providers a lower reimbursement rate than private insurance does.
The clinic has two employees who, in person, enrolled more than 2,400 people in Medicare or Medicaid after the Oct. 1 rollout of the ACA. Despite this, Settle estimates that half of the clinic’s patients are still uninsured — patients who make too much to qualify for Medicaid or large subsidies to buy private insurance through the ACA’s insurance marketplace, but who still cannot afford a monthly insurance premium.
“They’re waitresses or in retail or in a similar job, so they make a little too much to qualify for expanded Medicaid, so they were prompted to go to the marketplace and they purchased plans, but when it came down to what was covered — when they went to the drug store to get their insulin or they went to their first doctor’s visit and they had huge co-pays and deductibles — they realized they were paying for insurance that didn’t get them the care they needed,” she said.
Perry Bryant, executive director of West Virginians for Affordable Health Care, said the largest insurance subsidies offered by the federal government covered consumers who made below 200 percent of the poverty level and who purchased a silver plan, a mid-range health insurance plan offered under the ACA. According to Bryant, most consumers saw their co-pays and deductibles decrease, but for some, purchasing insurance in the first year may not seem worth it, as the tax penalty for not enrolling is $95 or one percent of a person’s yearly gross adjusted income.
“If they look at the gold or bronze plans, they don’t get the same assistance with their deductibles and co-pays, and they’ll be substantially higher,” Bryant said. “It’s those people who are just above 200 percent of the poverty level — the assistance with deductibles and co-pays goes all the way up to 250 percent of the federal poverty level, but for all intents and purposes, it stops at 200. It’s those people that I worry about the most.”
Bryant said even with the number of uninsured people dropping with the ACA, clinics like Health Right are still necessary, and provide needed access to the community.
“Health Right is a tremendous service in Charleston that really serves all of southern West Virginia; without them, a lot of people would forgo needed medical services,” he said.
Health Right — which also provides dental and vision care and frequently brings in specialists to work with patients — will have a place among health-care providers in the Kanawha Valley for the foreseeable future.
“Private physicians’ offices are balancing a budget. As long as there’s a shortage of providers, they’ll have the ability to pick and choose who they’re going to take and, unfortunately, the most at-risk of our population — low-income patients — are not going to be at the top of many lists,” Settle said.
Reach Lydia Nuzum at firstname.lastname@example.org, 304-348-5189 or follow @lydianuzum on Twitter.