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An B, Prabu V, Wallace LS. Accessibility, Readability, and Document Complexity of Medicaid Enrollment Materials and Resources. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.2001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kennedy AJ, Bakalov V, Reyes-Uribe L, Kensler C, Connor SE, Benson M, Bui T, Radomski TR. Free Clinic Patients' Perceptions and Barriers to Applying for Health Insurance After Implementation of the Affordable Care Act. J Community Health 2021; 45:492-500. [PMID: 31673862 DOI: 10.1007/s10900-019-00766-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite implementation of the Affordable Care Act (ACA), many Americans remain uninsured and receive care in free clinics. It is unknown what free clinic attendees in Pennsylvania know about health insurance expansion or what they perceive as barriers in enrolling in health insurance. The objective of this study was to assess the perceptions and experiences of free clinic patients from southwestern Pennsylvania when applying for health insurance after implementation of the ACA. We designed and implemented a survey of patients at three free clinics within Allegheny County, Pennsylvania from September 2016 to February 2017. Our survey included 22-items, 7 sociodemographic questions and 15 questions regarding the patient's health status and their perspectives related to obtaining health insurance. Data was obtained from 203 patient surveys; 110 (55.3%) of the respondents were men and 99 (48.8%) were African American. There were 48 respondents (24.1%) who did not report any income at the time of the study, and of those that did report an income, 92 (46.2%) respondents reported an income below 133% of the federal poverty level. The main barriers patients faced when applying for health insurance were: (1) lack of knowledge about health insurance (n = 127, 58.1%), (2) cost of health coverage (n = 85, 41.9%), (3) lack of resources (n = 83, 40.4%), and (4) lack of enrollment documentation (n = 43, 23.8%). Significant work is needed to better educate patients about their eligibility and options for health insurance. Free clinics can play a key role in eliminating barriers to health insurance enrollment.
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Affiliation(s)
- Amy J Kennedy
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Veli Bakalov
- Department of Internal Medicine, Allegheny Heath Network, Pittsburgh, PA, 15212, USA
| | - Laura Reyes-Uribe
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Caroline Kensler
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Sharon E Connor
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
| | - Maggie Benson
- Division of General Internal Medicine, UPMC Hamot, Erie, PA, 16550, USA
| | - Thuy Bui
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Thomas R Radomski
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15213, USA
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Alhallak I, Williams DK, Eudy R, Puryear E, Clark M. Impact of Student-Run Free Clinics in Urgent Care. J Community Health 2020; 46:522-526. [PMID: 32712823 DOI: 10.1007/s10900-020-00890-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As Emergency Departments (EDs) become increasingly crowded, the non-urgent use of EDs exacerbates this problem. Uninsured patients have the highest percentage of non-urgent ED visits and free healthcare clinics provide access to care for the uninsured. This study analyzed the patient population of the 12th Street Health and Wellness Center (HWC), a student-run free clinic (SRFC), to understand the impact of SRFCs in urgent care. 2024 return and new patient intake forms from the HWC were analyzed. Multivariable logistic regression was performed to see which factors from the patient intake forms increase the probability that a patient came will into the clinic for urgent care. About 10% of the HWC patient population uses the clinic for emergencies, of which, 94% of them were not referred to the ED. If the HWC was not available, most of these uninsured individuals would have gone to an ED and incurred an estimated total cost of $39,515.80 in 2019. Multivariable logistic regression indicated that patients that came via walk-in are significantly more likely to seek urgent care at the clinic. Further, patients without insurance and patients who need a Spanish interpreter have a higher tendency to seek urgent care at this clinic. SRFCs save their surrounding EDs thousands of dollars in non-urgent ED visits. SRFCs should be attentive to patients who come in without an appointment, without insurance, and who need a Spanish interpreter because they are more likely to come in for an emergency.
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Affiliation(s)
- Iad Alhallak
- College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, # 820, Little Rock, 72205, AR, USA.
| | - D Keith Williams
- College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, # 820, Little Rock, 72205, AR, USA
| | - Ruth Eudy
- College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, # 820, Little Rock, 72205, AR, USA
| | - Erin Puryear
- UAMS, 12th Street Health and Wellness Center, Little Rock, AR, USA
| | - Melissa Clark
- UAMS, 12th Street Health and Wellness Center, Little Rock, AR, USA
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Tabler J, Mykyta L, Chernenko A, Flores P, Marquez A, Saenz N, Stocker R. Hispanic Health Paradox at the Border: Substance, Alcohol, and Tobacco Use among Latinx Immigrants Seeking Free or Reduced-Cost Care in Southernmost Texas. South Med J 2020; 113:183-190. [PMID: 32239231 DOI: 10.14423/smj.0000000000001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health. METHODS Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588). RESULTS Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers. CONCLUSIONS Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.
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Affiliation(s)
- Jennifer Tabler
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Laryssa Mykyta
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Alla Chernenko
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Paloma Flores
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Alvaro Marquez
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Nancy Saenz
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
| | - Rebecca Stocker
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology and Anthropology, University of Texas Rio Grande Valley, Edinburg, the Department of Sociology, University of Utah, Salt Lake City, the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, the Department of Education, University of Texas Rio Grande Valley, Edinburg, and Hope Family Health Center, McAllen, Texas
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Zhang M, Garcia A, Bretones G. Demographics and Clinical Profiles of Patients Visiting a Free Clinic in Miami, Florida. Front Public Health 2019; 7:212. [PMID: 31428596 PMCID: PMC6688117 DOI: 10.3389/fpubh.2019.00212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Although the ranks of the uninsured in the United States have decreased in recent years, some states still lack Medicaid expansion programs, leaving many Americans, especially the indigent and homeless, without adequate healthcare coverage. Free-for-care clinics are oftentimes the last safety net for these vulnerable populations. Because these clinics have limited funding, a thorough understanding of the patients they serve is necessary to effectively direct their resources. The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida. Methods: Aggregate EMR data reflecting consecutive adult patient visits to the Miami Rescue Mission Clinic in Miami, Florida between January 1st, 2018 to March 15th, 2019 (n = 846) were reviewed for sociodemographic characteristics and chronic disease prevalence. Prevalence rates were compared by sex and to county estimates from the Florida Behavioral Risk Factor Surveillance System. Results: The most common conditions were mental health (19.3%), circulatory system (14.7%), and musculoskeletal system disorders (13.9%). Males had a greater prevalence of depression (difference = 6.6%; 95% CI [1.5 to 10.7%]; χ2 = 6.2; p = 0.013) and overall mental illness (22.0 vs. 10.4%, difference = 11.6%; 95% CI [5.7 to 16.4%]; χ2 = 13.2; p = 0.0003) compared to females, and male sex was identified as an independent risk factor for mental illness on multivariate logistic regression analysis (OR = 2.8; 95% CI [1.7 to 4.7]; p < 0.001). There was also a higher prevalence of depression (difference = 6.41%; 95% CI [2.1 to 10.2%]; χ2 = 8.0; p = 0.0047) and HIV (difference = 1.4%; 95% CI [0.3 to 3.0%]; χ2 = 7.3; p = 0.007) in male patients compared to county estimates. Rates of hypertension, diabetes, elevated cholesterol, asthma, and COPD were lower in the clinic population compared to the surrounding county. Conclusion: There is an acute need for mental health services in this population. The lowered prevalence of other chronic conditions is due to underdiagnosis and loss to follow-up. Such analyses are important in guiding policy decisions for meeting the health needs of vulnerable, at risk populations.
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Affiliation(s)
- Michael Zhang
- Miami Rescue Mission Clinic, Miami, FL, United States
| | - Alejandro Garcia
- School of Health Sciences, Miami Dade College, Miami, FL, United States
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Health Insurance Status and Eligibility Among Patients who Seek Healthcare at a Free Clinic in the Affordable Care Act Era. J Community Health 2019; 43:263-267. [PMID: 28831638 DOI: 10.1007/s10900-017-0414-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Free clinics provide care to over 1.8 million people in the United States every year and are a valuable safety net for uninsured and underinsured patients. The Affordable Care Act has resulted in millions of newly insured Americans, yet there is continued demand for healthcare at free clinics. In this study, we assessed health insurance status and eligibility among 489 patients who visited a free clinic in 2016. Eighty-seven percent of patients seen were uninsured, 53.1% of whom were eligible for health insurance (Medicaid or subsidized insurance premiums). The majority of these patients completed health insurance applications at their visit with the help of a navigator. A majority of patients who were not eligible for health insurance lacked citizenship status. This study highlights that a significant number of patients who visit free clinics are eligible for health insurance, and that free clinics are important sites for health insurance navigation programs.
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Insurance Enrollment at a Student-Run Free Clinic After the Patient Protection and Affordable Care Act. J Community Health 2018; 42:785-790. [PMID: 28260143 DOI: 10.1007/s10900-017-0318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) aims to increase insurance coverage through government subsidies. Medical student-run free clinics (SRFC) are an important entry point into the healthcare system for the uninsured. SRFCs do not have a standardized approach for navigating the complexities of enrollment. The Weill Cornell Community Clinic (WCCC) developed a unique enrollment model that may inform other SRFCs. Our objective is to describe enrollment processes at SRFCs throughout New York City, and to evaluate enrollment outcomes and persistent barriers to coverage at WCCC. We surveyed SRFC leadership throughout NYC to understand enrollment processes. We evaluated enrollment outcomes at WCCC through chart review and structured phone interviews. Subjects included WCCC patients seen in clinic between October 1, 2013 and September 30, 2015 (N = 140). Demographic information, method of insurance enrollment, and qualitative description of enrollment barriers were collected. SRFCs in New York City have diverse enrollment processes. 48% (N = 42) of WCCC patients obtained health insurance. Immigration status was a barrier to coverage in 21% of patients. Failure to gain coverage was predicted by larger household size (p = 0.02). Gender and employment status were not associated with remaining uninsured. The main barriers to enrollment were inability to afford premiums and lack of interest. Insurance enrollment processes at SRFCs in New York City are mostly ad hoc and outcomes are rarely tracked. Following implementation of the ACA, WCCC stands out for its structured approach, with approximately half of eligible WCCC patients gaining coverage during the study period.
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Patel A, Cadet VE. Free clinic educational interventions for patients with chronic disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40639-017-0039-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Patel MR, Jensen A, Ramirez E, Tariq M, Lang I, Kowalski-Dobson T, Pettway J, Famulare M, Lichtenstein R. Health Insurance Challenges in the Post-Affordable Care Act (ACA) Era: a Qualitative Study of the Perspective of Low-Income People of Color in Metropolitan Detroit. J Racial Ethn Health Disparities 2017; 5:78-85. [PMID: 28176158 DOI: 10.1007/s40615-017-0344-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Abstract
Low-income people of color are at risk of remaining uninsured due to a variety of factors. This study examined Affordable Care Act (ACA)-related and other health insurance enrollment experiences, observations, navigation needs, and experiences maintaining health insurance coverage among low-income communities of color in an economically disadvantaged community (Metropolitan Detroit). We conducted nine focus groups (n = 87) between May and June 2015. Participants were recruited through community-based organizations serving our key populations of interest. Using an inductive thematic analysis approach, codes and themes were generated. Findings from six themes demonstrated that although health insurance is perceived as important, confusion and frustration persist around health plan benefits and coverage, eligibility requirements and key provisions of the ACA, and enrollment. Individuals face difficulties justifying the cost of health insurance. More focused insurance outreach efforts are needed to achieve the ultimate goal of improving the health of low-income communities of color.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA.
| | - Alison Jensen
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, SPH 2, Ann Arbor, MI, 48109-2029, USA
| | - Erminia Ramirez
- Community Health and Social Services Center Inc., 5635 W Fort St, Detroit, MI, 48209, USA
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services, 2651 Saulino Court, Dearborn, MI, 48120, USA
| | - Ian Lang
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA
| | - Theresa Kowalski-Dobson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA
| | - Joslyn Pettway
- Covenant Community Care, 5716 Michigan Ave, Detroit, MI, 48210, USA
| | | | - Richard Lichtenstein
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, SPH 2, Ann Arbor, MI, 48109-2029, USA
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Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State. J Community Health 2017; 41:417-23. [PMID: 26512012 DOI: 10.1007/s10900-015-0112-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since the enactment of the Affordable Care Act (ACA), many people remain uninsured. While studies have examined this population, few have explored patients' experiences seeking insurance. To elucidate these individuals' perspectives, we surveyed patients (n = 80) at the University of Michigan Student-Run Free Clinic concerning their activity accessing insurance. Over half of respondents had sought insurance in the past 6 months; 57 % of respondents qualified for Medicaid by self-reported income (≤138 % FPL) and all but one were eligible for tax credits on the Health Insurance Marketplace. However, only 35 % of apparently Medicaid-eligible respondents had recently applied. There was no significant difference in the rate of applying for those above the income cutoff (p = 0.901). Perceived expense of plans and belief of ineligibility for Medicaid discouraged respondents from actively seeking insurance. Personalized outreach emphasizing new Medicaid eligibility requirements and tax credits may be needed to facilitate Medicaid enrollment for some uninsured persons under the ACA.
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Kominski GF, Nonzee NJ, Sorensen A. The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annu Rev Public Health 2016; 38:489-505. [PMID: 27992730 PMCID: PMC5886019 DOI: 10.1146/annurev-publhealth-031816-044555] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law's impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations.
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Affiliation(s)
- Gerald F Kominski
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; , , .,UCLA Center for Health Policy Research, University of California, Los Angeles, California 90024-3801
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; , , .,Center for Cancer Prevention and Control Research, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095-6900
| | - Andrea Sorensen
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; , , .,UCLA Center for Health Policy Research, University of California, Los Angeles, California 90024-3801
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