Free medical care: Too rich for Medicaid, too young for Medicare

Months ago, Willie, 62, a diabetic, was laid off from her job assembling hydraulic pumps. Even before that, she hadn’t had health insurance or medications for over a year. She gets up four or five times a night to urinate, which she thinks is “normal” for women of her age.

Out of curiosity, I asked why she waited so long to come to the Lorain County Free Clinic, where I work.

She said she'd never heard of it, and she’s lived in Lorain for years. Last week driving down Oberlin Road, she happened to see a new sign for the clinic (it recently moved).

I know this story.

I’m a county-hospital-bred-and-trained workhorse. Yet I knew very little about the other clinic, until I started working there.

Lorain County Free Clinic (LCFC) is one of the 50 member clinics that make up the Ohio Association of Free Clinics. The clinics are independent, offer different services, but are remarkably similar in scope.

Who qualifies?

LCFC provides free care for those whose annual income falls below $37,104 for one person; $75,948 for a family of four – that’s a lot of people.

Paul Baumgartner, LCFC's executive director, said, “We want to help those who are too rich for Medicaid, too young for Medicare.”

Lakewood’s North Coast Health, one of the two free clinics in Cuyahoga County, offers free to deeply discounted care for families with an annual income below $48,240 for one person; $98,400 for a family of four.

Gina Gavlak, president and CEO, said they want to extend their service beyond the uninsured to include people who have private health insurance but struggle with deep out-of-pocket expenses.

What services do the free clinics provide?

Comprehensive primary care is their calling card. Blood tests, imaging studies, emergency and subspecialty cares are done through the support of volunteer doctors, regional hospitals and clinics. Which means: if they can’t provide it, they know where to send you.

Another benefit – for which I’m perennially grateful – is the medication assistance program.

Both clinics have in-house pharmacies, which stock essential drugs for free or at a discount (an albuterol inhaler costs $5 at LCFC). For drugs obtained under the drug companies’ assistance program, dedicated staff help fill out and track the byzantine paperwork.

Is free care good care?

I work there: I’m as neutral as the color bubblegum pink.

Admittedly, I have my grunts.

Sleep studies aren’t free. While I can order a colonoscopy if a patient has a problem, I can’t for routine cancer screening. But I’ve learned to work around these inconveniences.

Next week, Willie will return for a free eye exam and blood tests. Once her sugar levels are under control, I assure her, she needn’t wake up five times a night to go to the bathroom.

I see half the load I used to in private practice. I don’t have time to finish her progress note before the next patient, but I don’t feel rushed. I feel like we covered good ground today.

That’s why I go back.