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Self-pay medical programs help uninsured

Citizen Staff Writer



The economic downturn’s toll on middle-class Tucsonans can be seen as teachers, administrators and even people with doctoral degrees join the growing numbers seeking medical care from programs that serve the uninsured.

“We’re seeing a lot of higher-skilled people coming in,” said Iris Vasquez, director of patient services at St. Elizabeth’s Health Center, 140 W. Speedway Blvd.

Michal Goforth, executive director of the Pima Community Access Program, said more people are turning to that program after being laid off and taking jobs that don’t offer health insurance or don’t pay enough to cover private insurance.

A teacher signing up for the access program said, ” ‘I never realized I would be in this situation,’ ” Goforth said.

The community access program and St. Elizabeth’s, formerly St. Elizabeth’s of Hungary, are self-pay health care programs serving Pima County residents who can’t afford health insurance and don’t qualify for the Arizona Health Care Cost Containment System, the state’s Medicaid program.

The access program charges an annual fee and offers reduced costs for local medical care to patients who meet eligibility standards based on the federal poverty level. St. Elizabeth’s charges patients fees for services on an income-based sliding scale.

Both programs depend on the support of local health organizations, patient payments and donations.

Vasquez said the number of applicants at St. Elizabeth’s has doubled from 30-40 a day last summer to more than 70 a day.

Even more were being seen in January – as many as 90 a day – until the clinic reduced the hours during which applications were taken to allow the staff time to process applicants’ paperwork.

St. Elizabeth’s stopped taking new AHCCCS patients last fall because the clinic was overwhelmed with self-pay patients, Vasquez said.

Individuals or families who might qualify for AHCCCS or the access program need to make an appointment to complete their application, Vasquez said. It used to mean waiting a week. Now, because so many people are applying, it takes 3-4 weeks, she said.

For Norma Padilla, 34, the access program is the reason her husband will be able to have surgery for a hernia. He had scheduled the elective surgery at UPH Hospital at Kino Campus, but was laid off from his job and lost his health insurance.

The person who helped him cancel his surgery at UPH Hospital referred Padilla to the community access program. Her husband found a new job, but it doesn’t offer health insurance and he makes slightly too much to qualify his family, which includes two children, for AHCCCS.

After meeting with PCAP representative Sonia Yanez on Feb. 11, Padilla was relieved that her family would be able to get some help with medical expenses.

While filling out the application for PCAP, Yanez checked to see whether the family would qualify for other services such as food stamps, cash assistance, or any other government programs. Again, the family’s income was just barely too high.

To be eligible for AHCCCS, an individual must make less than the federal poverty level, which is $10,830. A family of four – with children under age 18 – qualifies for AHCCCS’ KidsCare program if it makes up to $42,408, or 200 percent of the federal poverty level for a family of four.

To qualify for PCAP, individuals and families can make up to 250 percent of the federal poverty rate.

PCAP costs $40 per person per year. It offers reduced rates at local hospitals and area specialists. For example, a PCAP member will never pay more than $2,000 for a hospital stay and is responsible for 20 percent of the bill for an outpatient procedure.

Goforth said PCAP members are encouraged to use St. Elizabeth’s; El Rio Community Health Center; MHC Healthcare, formerly Marana Health Center; and other community health centers that charge patients on an income-based sliding scale.

Yanez said she is seeing a lot more people applying with PCAP who are receiving unemployment benefits.

Vasquez said some of those applying at St. Elizabeth’s have been jobless for so long that they are using the 20-week unemployment extension Congress passed and then-President Bush signed in November.

The stimulus package signed Tuesday by President Obama includes an unemployment insurance extension. It also offers some help for laid-off employees who, through the COBRA program, would otherwise have to foot the whole bill to be covered by their former employers’ health insurance plan for up to 18 months.

Under the stimulus package, the federal government will pay 65 percent of the COBRA premium for nine months, leaving the patient to pay 35 percent.

Even with the aid for people who get laid off, Goforth said she thinks the need for PCAP and self-pay health care services will continue to increase.

“People don’t see it, and nor do we, as a full-time fix,” Goforth said. “It is coverage to ease them through the gap. The question is, will that gap period be longer now?”

> Stimulus package to help unemployed afford COBRA, 5A

Continued from 1A

Self-pay medical programs helping the uninsured during economic downturn

For help

St. Elizabeth’s Health Center

140 W. Speedway Blvd., #100


Applicants are seen at the clinic from 8 a.m. to 11 a.m. and 1-3 p.m. Monday through Friday


Pima Community Access Program

Application stations are available at community health centers.

To find the closest center, call 694-0418


Both organizations need the following information to complete an application:

• Proof of address (utility bill such as electric, water or gas bill with your name on it) dated within past 30 days

• Picture ID

• Unearned income such as retirement, pension pay or award letter from Social Security for all family members

• Earned income (wages, all check stubs for prior and current month, for all family members)

• Social Security cards or Social Security numbers for those applying

• Proof of citizenship or alien status

• Copies of both sides of health insurance cards or the card itself

• Day care expenses

Pima County AHCCCS enrollees

As unemployment has risen, more county residents have qualified for AHCCCS.

2008 184,260

2007 174,262

2006 166,790

2005 168,419

2004 168,505

2003 153,300

Source: Arizona Health Care Cost Containment System

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