Children's health care gets boost New program pairs area physicians with uninsured youngsters

Cooperative effort

Participants say project will help fill void in coverage

October 13, 1997|By Jackie Powder | Jackie Powder,SUN STAFF

The Health and Wellness Care Program, an innovative project that provides medical care to uninsured children in Carroll County, has begun to pair its first clients with local primary care doctors.

The program, a collaboration among private and public health care providers, seeks to serve working-class families who fall into the "gray area" of health care -- they can't afford health insurance, but make too much to qualify for public medical insurance programs for low-income families, such as Medicaid.

"Our goal is to assign these people to primary doctors so they do not have to wind up using the emergency room as their doctor's office," said Karen Boswell, a board member of Carroll County Children's Fund, the nonprofit foundation that spearheaded the Health and Wellness Care Program.

"This way they'll have a home base and a doctor familiar with the child's history," she said.

Ten children have been enrolled in the program, which has 25 physicians and nurse practitioners in its provider network.

"It's a wonderful thing for middle-class people," said Barbara, whose two teen-age daughters will receive routine, preventive medical care through the program. The woman asked that her last name not be used.

"My husband has worked in construction for 20 years, and we don't have health insurance," Barbara said.

Her daughters haven't had serious health problems, but when they have had to see a doctor, it cost $50 a visit.

"It's so rough for us to think about doing that, but we need to," Barbara said.

Dr. Jennifer Wehberg, a participating doctor in the Health and Wellness Care Program, said the project will help to fill a gap in the county's health care delivery system.

"We see a lot of families that fall into that gray area," said Wehberg, who is with Carroll Children's Center in Westminster.

Carroll County Children's Fund estimates that 500 to 700 uninsured children might be eligible for the new program. Boswell said the fund is seeing more cases in which a parent has a part-time job that provides insurance coverage for hospitalization, but none for routine doctor visits.

The nonprofit foundation was created in 1983 by Westminster pediatrician Dr. Karl Green to pay for the medical needs of BTC acutely ill children with no insurance. Last year's closing of the county Health Department's pediatric care clinic led Carroll County Children's Fund to expand its services.

The Health and Wellness Care Program is a joint effort involving the county Health Department, Carroll County General Hospital and New American Health, a managed-care organization.

On Oct. 1, public health nurses with the county Health Department began screening families for the program's income eligibility requirements. Families with incomes up to 250 percent of the poverty level qualify. Under those guidelines, the maximum income for a family of four is $38,190.

Eligible families may select a primary care doctor from participating physicians. New American Health will pay physicians in the network a yearly capitation rate of $246 for each member. The plan includes free regular checkups and well-care visits and limited coverage for prescriptions, lab and X-ray services. Providers may charge $5 for sick visits.

Carroll County General Hospital will absorb hospitalization costs associated with the program.

Patricia Rutley-Johnson, director of prevention and wellness services at New American Health, said the program expects to enroll about 75 children in its first year.

Carroll County Children's Fund will serve as the fund-raising arm of the Health and Wellness Care Program and will cover the cost of the insurance premiums through New American Health.

Applebee's Neighborhood Grill and Bar, which is opening a restaurant in Westminster next month, is one of the program's sponsors. The restaurant will cover the annual capitation fees for 10 children in the program's first year, about $2,500.

"The Health and Wellness Care Program really struck a chord with us, because we're an employer of people who may just fall into that gray area," said Karen Glaeser, marketing manager for Rose Casual Dining, the Philadelphia-based restaurant developer of Applebee's in the Baltimore area.

Carroll County Children's Fund is seeking financial support for the program from local businesses, churches and civic groups that might want to cover the annual medical costs of one or more eligible children.

The fund's annual dinner meeting will be at 6: 15 p.m. Oct. 27 at Martin's Westminster. The guest speaker will be Nancy S. Grasmick, state superintendent of schools. Information and tickets: Herb Findeisen, 410-857-1000.

Pub Date: 10/13/97

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