In her final days as clinic administrator, Sheri Noble has a parting plea for the 400-odd patients she’s seen come through the Good Samaritan Care Clinic the past year: Apply for Medicaid.
The rules have changed, she’s explained. And because the free clinic, run from a converted church parsonage for the last 17 years, is closing its doors next month, she wants them to be able to find another doctor they can afford to see. Financial straits caused by the pandemic are one reason for the closure, but so is Missouri’s recent expansion of Medicaid, which gives many patients a better healthcare option.
So between scheduling final visits to transfer medical records or refill prescriptions, the clinic is offering a session in front of a computer with a volunteer, to get help filling out a form for the state health program.
It’s hard work. The clinic has mailed closing notices to all of its patients, with a suggestion to apply for Medicaid. But many don’t have Internet or reliable phone service at home. Others are hard to reach, changing addresses frequently. After years of being denied, some don’t believe they’ll qualify.
As of Monday the clinic, located in the Ozarks about 100 miles east of Springfield, had helped about ten patients apply. Another eight were scheduled that day. Noble estimates 70% of the clinic’s patients will qualify, and hopes others have applied on their own.
“Patients have become very cynical about Medicaid expansion,” she said. “The patients that most desperately need it were really not well-informed about what was going on and had become, through the years, maybe a little leery of the fact that Medicaid expansion would ever go through.”
Health advocates across Missouri celebrated a long-awaited victory this month when the Department of Social Services began processing applications for the expanded Medicaid program and enrolling those who qualify. It came after numerous hurdles to the plan’s implementation and nearly a decade of Republican opposition to the policy that was part of the Affordable Care Act.
Expanded eligibility means as many as 275,000 low-income Missourians can get on the program. For years, advocates have pointed to it as one way to improve primary care and the state’s bottom-of-the-nation health outcomes. As of early October, about 17,000 have applied and 4,300 applications have been processed.
Now, more than a year after the ballot measure expanding the program passed by a statewide vote, and more than three months after the courts ordered it implemented, the work connecting the uninsured to Medicaid falls to frontline staff like Noble in clinics like Good Samaritan.
Outreach efforts are underway across Missouri at organizations that serve low-income clients. Legal Services of Eastern Missouri, which brought the lawsuit to force the expansion’s implementation this year, has held events to aid in signups. The Missouri Primary Care Association, which works with a network of low-income clinics, has been training its member clinics’ staff on the new policies to assist their patients in applying.
“People don’t know that they’re actually going to be eligible because they had been denied before, and then [barrier] number two is not knowing where to go to apply,” said Iva Eggert-Shepherd of the Missouri Primary Care Association. “And that’s where the health centers step in … People in Missouri already trust them.”
For the Good Samaritan Care Clinic, the outreach effort is particularly critical for enrollment. It serves counties with some of the state’s poorest residents, yet expansion in this region was politically unpopular, receiving two votes against every one in favor last year.
“The only way we would have heard was by word of mouth,” said Camille Boyers, 65, who along with her sister Anita, 62, came to the clinic Monday to fill out an application.
The Boyers, of Willow Springs, have struggled to find work suitable for their age. They don’t get Internet, television or newspapers at home. If approved for Medicaid, they said they expected to receive more preventive cancer screenings recommended for women.
“Some patients I feel like are going to be maybe so confused or uninformed about the new guidelines that they’re never going to take the next step to reapply,” Noble fretted as phones rang nonstop from patients coming for their final visit. “That does weigh heavy on my heart.”
‘They can always say no’
Like most of the patients Noble has contacted, Carolyn Hayes had no idea Medicaid eligibility had been expanded. She didn’t know there had been an election last year, or a court decision this year.
Clutching a paystub and a utility bill in the clinic’s waiting room, Hayes said she assumed that between her salary and late husband’s disability checks, the household made too much for her to qualify.
Since her husband’s death last year, she’s lived alone. She is paid $11.95 an hour, part-time, as a personal caregiver for a home health company, cooking, cleaning and picking up groceries for elderly clients.
The 55-year-old said she had health insurance many years ago, through a previous spouse’s job. For the past several years, she’s been relying on regular trips to the Good Samaritan Care Clinic for free blood pressure medication and tests to monitor her high cholesterol.
Two years ago, Hayes said she needed cataracts in her eyes removed. When a specialist in Springfield told her it would cost $10,000, she and her late husband found a Poplar Bluff eye clinic that would take a low-interest healthcare credit card. The procedure was done at the clinic’s facility in Illinois, four hours from Hayes’ home in Summersville. The couple saved for months to pay off the $4,600.
Expansion is expected to cover people like Hayes, working adults who don’t make enough for private insurance. It allows single adults making up to $17,774 a year to enroll.
Hayes wasn’t sure if she would qualify. Her hours vary week to week, making her annual income unpredictable.
‘Falling between the cracks’
The Good Samaritan Care Clinic was never meant to last forever, its founders say.
It sits in Howell County, where about a fifth of adults don’t have health insurance, and is surrounded by a cluster of Missouri counties with similar or higher rates. To the south, several Arkansas counties have comparably low household incomes, but rates of uninsured adults are under 15%. Arkansas expanded Medicaid in 2013.
A doctor from the neighboring Shannon County, Jon Roberts, founded Good Samaritan in 2004 with a group of local residents concerned about health care access in rural southern Missouri.
The clinic runs on donated medical equipment. Noble is the only staff member; a rotating cast of volunteer doctors and nurses from as far away as Springfield or Poplar Bluff sees patients, who must be uninsured to visit. Before the pandemic, Monday night clinics were first-come, first-served and drew a line out the door. In its years of operation, volunteers have performed more than 34,000 medical and dental visits.
At its peak, Noble said, the clinic saw between 800 to 1,000 patients a year, predominantly for chronic conditions such as diabetes and hypertension. Many work in the region’s sawmills, or low-wage fast-food and retail jobs, she said. When they needed referral to a specialist or a hospital, Noble and volunteers filled out applications to get them approved for financial assistance.
When the pandemic hit, volunteers and donations were harder to come by. A local hospital that had been providing free lab work recently sold the lab, which would increase costs for the clinic. Noble herself had been putting off moving away, to keep the clinic going.
But with expansion underway, the clinic’s board decided it was time to pass the patients on to others.
“We were here to provide services to patients who were falling between the cracks, who… their needs weren’t being met by any other niche in society,” Noble said.
“Once that need has decreased, it’s OK that we move on and close our doors because they’re going to be able to get assistance elsewhere. That’s our goal.”