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Health Care for All's Pam Dixon, Hillary Lofton-Everidge, Catrina Trumble-Corey and Shawana Morris
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Photo by Tracie Morris/Donn Young Studio
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The old man didn't want to tell them out loud
the amount of his retirement income. Even though they were sitting inside his
apartment, filling out his Medicaid form. "He wrote it on a piece of paper," Catrina
Trumble-Corey says. "He thought his neighbors might be listening."
Trumble-Corey supervises a five-person team of "walkers and
talkers" -- outreach workers for the program Health Care For All. Outfitted
in their usual khaki shorts and maroon polo shirts, the team had just spent
a few hours knocking on doors in the B.W. Cooper (Calliope) housing project.
If anyone is uninsured, the Health Care For All team can -- on the spot -- complete
an application, either for Medicaid, the public-health plan for low-income people,
or for LaCHIP, the health-care plan for children.
The walkers and talkers use handheld scanners to scan in documents
like birth certificates, medical bills and social-security cards. If anyone
lacks these documents, the outreach team secures the paperwork through the local
Social Security office or the vital statistics offices in any state.
Unless the temperatures get too high or turf wars turn too
violent, walkers and talkers spend nearly every workday in B.W. Cooper. They've
done so since April. Before that, they door-knocked in the now-demolished St.
Thomas project and then in the working-poor area around St. Thomas.
This day is not unusual as far as the work they're doing. But
today, visitors from San Diego are here, watching the team make its rounds.
Afterward, everyone returns to the Kingsley House, where Health Care For All
is based. The San Diego visitors give a full report, starting with Trumble-Corey
and the elderly man.
The man had allowed Trumble-Corey to bring one visitor into
his apartment, and she has plenty to say about the experience. "We had a real
character," she says. "What impressed me was that, no matter what curve
he threw, Catrina was patient." At one point, the old man had mentioned that
he had a shotgun in the house. No reaction from Trumble-Corey. Then the man
was hesitant about handing over his Social Security number. She told him, "That's
fine -- they'll mail back something telling you what they need."
Program Manager Tammi Fleming listens and nods her head. "With
the elders, we won't push that much. Because if they receive something in the
mail, they'll send it back. It's the young ladies with the children that we
try to follow through on -- because sometimes something else might come up and
they might not follow through on their own."
Welcome to the world of Health Care For All, where Fleming
and her staff of seven are honing health-care outreach into a fine art. They've
been so successful that, in the past few months, several teams of outreach workers
-- including the current visitors from San Diego -- have flown in from other
cities to watch them at work.
Dr. Marcia Bayne-Smith explains that the high visibility, door-to-door
approach used by Health Care For All relies on neighbors talking to each other.
A professor of urban studies at Queens College in New York and a consultant
for the Baltimore-based Annie E. Casey Foundation, which partly funds Health
Care For All, Bayne-Smith is helping to facilitate the visit from San Diego,
using observations from B.W. Cooper as a lesson.
The idea, says Bayne-Smith, is that when you sign up one resident
for LaCHIP or Medicaid, she will knock on her friends' doors and tell them "you
need to get health insurance for your child." It uses what Bayne-Smith calls
"social glue, that network of families and neighbors found in poor neighborhoods.
These relationships help people in ways that no government programs can do."
A member of the San Diego team weighs in on that point. "We
only got as far as the stoop," she says. "Pam had enrolled two out of three
women, and the third was very eager to sign up." While they were outside, she
notes, several other people came up to say hi or ask for information.
The success they've witnessed today is the result of smart
recruitment, intensive training and hard work, emphasizes Bayne-Smith. "None
of what you've identified came by accident," she says.
Fleming tells the San Diego group that when she hires, she
looks for raw communication skills -- the ability to converse about any subject
with any person. "You can say, 'What about this cold drink?' to Pam [Dixon]
and she can give you three hours on a cold drink," she says.
Walkers and talkers start out with an intensive month-long
training period, during which they polish communication skills and role-play
different scenarios. Fleming demonstrates the role-playing by calling on Dixon.
"Pam -- act like a person who doesn't want to be bothered," she says, and Dixon
acts expertly like a young woman with an attitude who "really doesn't feel like
filling out any forms today."
Everyone laughs. But Fleming points out that people have reason
to be wary, even hostile. "Folks like us have been knocking on those doors and
not been honest." She recalls that 15 people were evicted from St. Thomas after
one group conducted a survey and weren't forthright about how they were going
to share their information.
Some residents may also be going through traumatic times, dealing
with domestic violence or with the death or incarceration of a loved one. "So
if they don't have a child sick, maybe they really don't have the time to deal
with this right now. We are always quick to criticize. But I was a teen-age
mom at the St. Thomas, outside playing cards."
"I met Tammi 13 years ago," recalls Bayne-Smith.
"She was 17 years old, had a baby, was on welfare. She started as a volunteer
for Plain Talk, our teen pregnancy prevention program. She wasn't even getting
paid. But she went to school at night, got her GED, bachelor's, then master's
in public health."
"It took us years to get Catrina off the porch,"
adds Fleming. "Some of your most reluctant people can become key messengers
for your program."
When it comes to health care and social services,
Louisiana is usually ranked 49th or 50th in the United States. Yet the state's
efforts to enroll children in LaCHIP have been ranked at the top of the charts
by several health-care advocacy groups. Currently, the state has, on its Medicaid
and LaCHIP rolls, 553,000 children. Of those children, 238,000 -- 43 percent
-- were uninsured when the state launched LaCHIP in 1998.
A high portion -- 79 percent -- of LaCHIP's
medical costs are paid for by the federal government, through national legislation
that in 1997 created the State Children's Health Insurance Plan (SCHIP). SCHIP
was designed to help working families whose incomes were too high to qualify
for Medicaid but too low to afford private insurance. State plans vary; children
in Louisiana are eligible for LaCHIP if their household's income is up to twice
the federal poverty level.
Louisiana's efforts have been lauded on a
few fronts, including the application itself, which can be used for both LaCHIP
and Medicaid kids (adults 19 years old and older have a separate six-page Medicaid
form). "We shrunk it from what used to be 14 pages down to two pages, written
in plain English," says David Hood, secretary of the state Department of Health
and Hospitals (DHH).
Louisiana is also doing well with renewals,
which must be completed every 12 months. "You have to be sure there's not a
hole in the bucket, that you're not losing children faster than you're adding
them," explains Ruth Kennedy, who as deputy medical director for DHH oversees
the state's outreach efforts.
Still, even with those efforts, many children
remain uninsured. In Louisiana, according to a recent Urban Institute report,
202,700 children -- or 17.6 percent of kids in the state -- currently lack insurance.
Two-thirds of those children are eligible for LaCHIP or Medicaid.
Louisiana's situation is paralleled nationwide,
says Sarah Shuptrine, president of the Southern Institute for Families and head
of Covering Kids and Families, a $97 million Robert Wood Johnson Foundation
initiative focusing on SCHIP and Medicaid outreach. "Many, many children below
poverty are not enrolled in this program," says Shuptrine. "Often families with
eligible children simply do not know about it or don't know how to enroll."
Dorthea Brimmer used to take her little girl
to Charity Hospital. Her daughter, now 13, once had asthma, which she now seems
to have outgrown. During the past two years, she's only been to the hospital
once, when she got a piece of glass stuck in her foot.
"Knock on wood, she's been healthy," Brimmer
says. "But I feel like she has more protection now. With her LaCHIP card, I
can get an appointment for her either at the St. Thomas health clinic or at
her own personal doctor." Brimmer enrolled her daughter in LaCHIP in 1999, when
she lived in the now-demolished St. Thomas housing project, the first targeted
by the Health Care For All team.
Children who lack health insurance are less
likely to get the medical care they need, experts say. Parents of uninsured
children are more likely to put off doctor visits. According to the American
College of Physicians, uninsured kids are five times more likely to use the
emergency room as a regular source of care. Uninsured children are more likely
to be sick as newborns and less likely to be immunized as preschoolers. If a
child is uninsured, readily treatable health conditions -- dental cavities,
middle-ear infections, poor eyesight, and asthma -- are much more likely to
go undetected. These conditions can increase school absences or make reading
and learning more difficult.
When Brimmer started a new job, her daughter
was knocked off of LaCHIP. "I had reported my job, but the computers made a
mistake," she says. She talked to the Health Care For All team, and the approval
papers were in the mailbox the next week, she says.
"You really become more of a caseworker for
that person once you do that initial survey," says Fleming. Parents have one
thing in common, she says. "Every mother, whether she's on crack, welfare, or
has a million dollars, wants the best for her kids," she says.
Health Care For All began in 1999, armed with
data showing that local housing projects were fertile territory for health insurance
outreach. Using income statistics, the Housing Authority of New Orleans (HANO)
had projected that the city's nine housing developments held 30,000 eligible
children. Families in the projects are often labeled hard-to-reach.
"Some would-be recipients," says DHH's Ruth
Kennedy, "need the type of outreach that the walkers and talkers with Health
Care For All provide, that one-on-one assistance in completing the application
and conveying the message that this is something they really do qualify for."
In an economic downturn, outreach of any sort
continues to be crucial, says Donna Cohen Ross, the director of outreach for
the Center on Budget and Policy Priorities. "Families are less secure now,"
she says. "People are losing their jobs along with, perhaps, the employer-based
health-insurance that came with it."
Indeed, economists for the Henry J. Kaiser
Foundation estimated last year that for every percent point rise in the unemployment
rate, 1.2 million people become uninsured. These newly unemployed people might
not have listened to previous outreach efforts because they had health coverage,
says Cohen Ross. "They could be considered an entirely new audience," she suggests.
Members of the Health Care for All team pour
coffee into their cups and walk into the Kingsley House conference room for
their Monday morning meeting. Program director Tammi Fleming sits at the head
of the table, surrounded by the rest of her team. It's a close-knit group: secretary
Hillary Lofton-Everidge, supervisor Catrina Trumble-Corey and the five walkers
and talkers -- Pamela Dixon, Sandra Faulk, Shawana Morris, Letha Richardson
and Marian Jordan.
Fleming reminds her staff to check their voice-mail
messages regularly, that they "don't want people to say we have the same bureaucratic
delays as the welfare office." They then discuss the previous day's fatal shooting
in B.W. Cooper, on Thalia Street. Before they head out to the field today, they'll
feel out the situation with the B.W. Cooper management office.
This summer's turf war has meant that the
team can't make night visits to locate qualified residents who work during the
day. "We're hoping the cooler weather will bring some calm to those communities
so that we can do some evenings," says Fleming.
Next on the agenda is a report from Trumble-Corey.
Within the first six months of 2002, she calculates, Health Care for All completed
509 applications. Their annual program goal is 600 enrollments per year; last
year, says Fleming, they enrolled 850 total people, 40 percent over that goal.
This year, they're on track to do even better than that.
To date, Trumble-Corey says, they have made
contact with 56 percent of the 1498 units in B.W. Cooper. Once they have reached
80 percent, they will move on to another area, maybe to the Guste or St. Bernard
housing projects or to the working-poor neighborhoods around B.W. Cooper.
Pamela Dixon walks down Galvez Street and
knocks on a door emblazoned with five bumper stickers that say "My child is
a New Orleans Public School scholar." A woman opens the inside door and speaks
through the screen door. "Good morning, how are you doing?" says Dixon. "My
name is Pamela, I work for Kingsley House. We have a contract with B.W. Cooper
to go from door to door to find out if any kids or adults in your household
need free health insurance."
First, the woman takes the Health Care For
All household survey. She has two kids, she says; they're already covered by
Medicaid. Dixon thanks her for her time and walks over to the next building.
She marks her paperwork. "This was my eighth time to that house. I got lucky,"
she says.
After stopping at several more doors, Dixon
heads off to meet her co-workers. Letha Richardson has stopped a little short
of their scheduled rendezvous point. She's talking with a 19-year-old man named
Ernest; on her clipboard is a Medicaid application indicating that he has a
stack of recent medical bills. Richardson tells him that Medicaid will reimburse
him for bills up to three months back.
Ernest says that he thought he didn't qualify
because he isn't on welfare. It's a common misconception because, in the days
before welfare reform, the programs used to be linked.
Richardson finishes up with Ernest and then
walks toward the car with Dixon and Shawana Morris. Richardson points out that
she wasn't simply completing Ernest's form. "I let him sit there and watch me
fill it out," she says. "I was trying to teach him so that next time he could
do it his own self."
As the team members stroll toward the B.W.
Cooper management office, several other residents approach and ask questions
about various policies and invoices. "That's what we took all this training
for -- to educate our community," says Dixon. It's getting to be late afternoon.
The three women pile into the hot car and head back to the Kingsley House.
