Where to go for low-cost — or free — medical help

With Washington's economy in a serious slump and job layoffs on the rise, the state's health-care safety net has taken on increased importance. What's available if you need health care and don't have health insurance? The good news: At least in King County, low-cost or free health care is available for children of low-income parents, though many who are eligible have not taken advantage of it. The bad news: Options are limited for adults of moderate income who don't have insurance through their employers.

Children

Health-care coverage for kids, rather than adults, has been the federal and state priority, through two programs:

• Medicaid, providing free health care to children of poor parents. In this state, parents can't make more than 200 percent of federal poverty level, or a total of $35,300 for a family of four.

• The state's Children's Health Insurance Program, or CHIP, targeted at children whose parents barely miss qualifying for Medicaid.

Two who got help Those who have received health care through low-cost programs include: • A 52-year-old grocery-store clerk who recently suffered a massive stroke and is unable to walk or speak. Because her husband had to leave his bus-driving job to care for her, they have no work-linked insurance and too little income to afford it. She is receiving low-cost care at Rainier Beach Medical Clinic, part of a network of community health clinics. • A pregnant, 25-year-old woman who is receiving prenatal care at the same clinic. The woman's husband works as a nursing assistant but has no health insurance through his job and earns too little to buy it for his family, which includes a 21-month-old child. The woman hopes to find work in domestic service after her baby is born, but it's unlikely the job will provide health insurance or enough income to buy it.

The children receive health insurance costing $10 per child a month, up to a $30 per family. Parents can't earn more than between 200 percent and 250 percent of the federal poverty level: between $35,300 and $44,100 for a family of four.

Some work-related costs, such as child care, can be deducted from total income, helping parents qualify.

The application for both programs is the same, says Liz Mercer of Community Health Access Program, a social-services agency that helps low-income parents obtain health insurance for their children.

Years ago, signing up for Medicaid was complicated, but in recent years, Mercer says, the state simplified applications, requiring less paperwork.

Adults

A very limited number of low-income adults are eligible for free care (through Medicaid); more qualify for low-cost health care through the state's Basic Health Plan, but the plan limits the number who can enroll and right now there's a long waiting list.

And if you make more than 200 percent of the federal poverty level, or if you are eligible for Medicare, you can't buy an individual policy from the Basic Health Plan.

Several insurance companies, including Regence Blue Shield, Group Health Cooperative of Puget Sound and Premera Blue Cross, offer individual policies. However, these can be expensive, depending on what's covered and the deductible level. It is also possible to buy an individual health-insurance policy through the Washington State Health Insurance Pool, but this also is expensive because it includes people whose existing health conditions might otherwise exclude them from insurance coverage.

For uninsured people who don't qualify for, or can't afford, these programs, these choices are possibilities:

• Community health clinics: The 22 community health clinics in King County (170 in the state) offer sliding-scale fees based on income. Though almost all patients who seek clinic treatment are low-income, the clinics treat people of any income.

The waiting time for seeing a doctor is about on par with other medical clinics: about two weeks for nonurgent care and immediately for urgent cases.

"We're anticipating much larger numbers of people who are going to be needing (assistance with) health care" as the recession continues, said Sharon O'Dell of Puget Sound Neighborhood Health Centers, the nonprofit organization that operates 15 community health clinics in Seattle.

• Simple Care: This is a grassroots system of about 120 King County health-care providers — including family doctors, pharmacists and specialists — who offer discounts of 20 percent to 50 percent if a patient pays cash. Keri Andrews, a spokesman for the Renton-based group, said the providers, by bypassing the costly and laborious process of billing insurance companies, can pass big savings along to the patient. An average visit may be $35-$65, compared with $79-$109 if billed to insurance.

• Hospital charity care: If you've seen a doctor and you need surgery or other hospital care but are low-income and have no insurance, "charity care" at a hospital is an option. In addition to mandatory emergency care, state law requires hospitals to provide "necessary inpatient and outpatient hospital health care ... to indigent persons" whose income is at or below 200 percent of the federal poverty level. Such care is free to those with incomes at or below the poverty level, and on a sliding scale for those who earn 100 percent to 200 percent of the level.

Whether state hospitals provide adequate information to patients about how to get charity care has been a matter of controversy in recent years, but reports filed with the state Department of Health show that hospitals spend around $117.7 million a year on charity care, with Harborview Medical Center spending the most, at $27.4 million in 2000.

Judith Blake: jblake@seattletimes.com