By Patrick Winderl/Havre Daily News/pwinderl@havredailynews.com
People in Hill County with little or no health insurance may have access to low-cost health care as early as next fall.
The Hill County Health Department will seek grant funding to assess the needs of residents with minimal health insurance coverage - or none at all - and study the possibility of establishing a community health center in Havre. If both studies show the need is there, the department will seek funding for the health center.
The center, which would be located downtown, would offer a sliding-fee scale based on patients' ability to pay.
According to 2002 census information, about 4,000 of the county's 16,372 residents have no health insurance, county nursing director Cindy Smith said. Of those 4,000 people, 10 percent are unemployed. The number of people who have minimal health coverage has not been determined, Smith said.
"Some people just fall through the cracks," Smith said. "The purpose behind all of this is to identify people who would benefit from a community health center - those people who have to come up with $400 just to get through the door" of a doctor's office.
One problem is many health care providers do not accept Medicaid, Smith said. The reimbursement given to providers from the government is minimal, meaning there is little incentive to accept Medicaid patients, she said. For instance, a number of people must travel to Helena for specialized health care needs because local providers did not accept Medicaid.
"Right now, there are pockets of people who on't even bother trying to receive health care," Smith said, because they're so used to being turned away.
According to an informational packet provided by the County Health Department, the goal of the community health center would be to "move Hill County toward a system of care in which every child and adult has access to high quality care in an atmosphere that preserves the dignity of the person being served, as well as the fiscal integrity of the organizations and individuals involved in health service and delivery."
During a meeting Tuesday, Smith met with local health care providers, government officials and area legislators.
Smith and other county leaders acknowledged that the plan will not be successful unless local health care providers support and participate in the process.
"It's not something we take lightly," said County Commissioner Doug Kaercher. "We need most of the medical community to be on board for this work."
During the meeting, Smith outlined the Health Department's goals and asked for volunteers to serve on a team to identify people who may benefit from a community health center, to coordinate efforts with the community, and to meet regularly to track progress. Team members will include people from the medical community, local leaders, senior citizens, youths, educators and parents.
"We don't want to design the system," Smith said. "We want the community to design it."
Northern Montana Health Care plans to participate in the process, Christen Obresley, Northern Montana Health Care's compliance auditor, said in a press release.
"This is a project that deserves full evaluation. We plan to work with the consortium to do the research needed to determine the feasibility," the release said.
In April, the Health Department will apply for funding from the U.S. Department of Public Health and Human Services' Healthy Communities Access Program. Last year, almost $35 million in HCAP grants was awarded to more than 30 U.S. communities.
An HCAP grant is ideal because of the amount of money typically awarded. The average grant amount is $900,000, Smith said.
"HCAP money will help do a a lot. Otherwise, I'll have to write for 50 different grants, and do it slowly over time," Smith said.
HCAP money can be used for team building, needs assessment and service planning. Only 15 percent of the money can be used for direct service delivery, and none of it can be used for construction or to pay licensing fees. That means the Health Department will have to apply for a follow-up grant to actually fund the center, Smith said.
In order to receive a follow-up grant, the Health Department will have to show that Hill County has a need for a community health center, and will have to develop a comprehensive plan for it. Because the community health center would be a county entity, it will also need approval from the County Commission.
"This is going to take a considerable amount of time on the part of the staff, and before we go ahead with the approval, we need more information," Kaercher said.
The needs assessment will be a critical step in the process, Smith said, adding that there is no doubt the results will demonstrate a need for a community health center.
"I think it will show that there's a need," she said. "It's just a matter of how big, or how small, and whether we contract with existing providers, or whether we have stand-alone people at the center."
Area legislators who attended the meeting said the number of people in Montana without health insurance is high and is increasing.
"Statewide the figure is about 19 percent," said state Rep. John Musgrove, D-Havre. "That's embarrassing. It's obvious we're not meeting the needs of all the folks with medical problems."
State Sen. Jon Tester, D-Big Sandy and Senate minority leader, said the information derived from the needs assessment will be useful.
"I think it's a step in the right direction," Tester said. "What I got from the meeting is they're going to try to analyze the needs within the community. As legislators, we need to have that information."
If the needs assessment determines that there is a need for the center, and funding is secured for its development, the center may expand to provide services to residents in nearby counties.
"Because our surrounding counties may not have the resources to do something like this, we hope it would be beneficial to them as well," Kaercher said "To begin with, however, we're just going to focus on Hill County. Slow and cautious is how we're approaching this."
The number of people without insurance who come to the Health Department seeking help is staggering, Smith said.
"This morning, we had one person come in who was not Medicaid eligible, and had an ear infection," she said. "We gave them a voucher for a prescription at one of the local pharmacies, but I have a very small pot of money to do that with. We get calls from people every day who say they don't have insurance, and we don't have the resources to help them all."
