2013-07-05 / Community

Residents help others navigate health care

By Jack Flagler
Staff Writer

CAPE ELIZABETH – For the last 12 years, the CarePartners program has helped nearly 10,000 uninsured and low-income Maine residents receive medical care from a network of more than 900 health care providers, including Cape Elizabeth doctor Chris Wellins.

Wellins is an internist, meaning he sees adult patients with both chronic and acute illnesses. He began participating in the CarePartners program about five years ago and said the greatest benefit of the program has been the ability to continue treating a patient who, for example, has lost his or her job, and otherwise may have to discontinue care.

“They either won’t come in for an appointment or they’ll say, ‘I can’t come in because I can’t pay you,’” Wellins said.

When that happens, Wellins said the CarePartners program is “one of the top tools in the toolbelt” to help people continue getting the care they need.

Carol Zechman, director of CarePartners and a South Portland resident, said the average CarePartners enrollee is 42 years old with an income of $16,000 per year, but enrollees include a broad spectrum of Maine’s population.

“There are a lot of younger individuals in the service industry, and there’s a lot of people 55 and older that for whatever reason are no longer working, but can’t get on Medicare,” Zechman said. “The majority are employed. They are the working poor.”

The CarePartners program has operated since 2001 in four Maine counties: Cumberland, Waldo, Kennebec and Lincoln. In that time, it has helped uninsured and lowincome patients receive care for $10 an office visit and $10 to $25 for prescriptions.

But next year, the program will go through a major organizational change. Its focus will shift from helping the uninsured receive care to helping them navigate the online insurance marketplace as part of the 2010 Affordable Care Act.

As of Jan. 1, all Americans who do not meet certain criteria will be required to have health insurance or pay a penalty. While volunteer health care providers like Wellins will not stop offering their services to patients, many of the individuals enrolled will be subject to a fine if they do not buy a plan through the online marketplace.

The U.S. Department of Health and Human Services launched a new website, HealthCare.gov, on June 24 to help uninsured and underinsured patients navigate the new marketplaces, which will be administered in Maine by the federal government.

The details of the available plans still have not been formalized, but low-income patients will qualify for subsidies based on a sliding income scale, Zechman said. The individual and small-group plans will be available through the marketplace starting in October.

Zechman said the CarePartners program will still exist on a smaller scale for those exempt from the new health care requirement, including those who make less than the threshold to file a tax return – $10,000 for an individual – as well as those who would need to pay more than 8 percent of their income for health insurance. The staff size of CarePartners will not be reduced, but many staff members will transition to new roles helping patients navigate the new marketplace, rather than coordinating care.

Despite the significant changes and high level of uncertainty ahead for the next few months, Zechman said she is looking forward to the changes the Affordable Care Act will bring to health care in Maine.

“Anything that’s going to bring greater access, we’re excited about,” Zechman said.

Wellins said he does not expect the patients he treats through CarePartners to experience a decrease in medical service because of the changes ahead.

“Our goal is to see the patients that need to be seen. I don’t think that’s going to change all that much moving forward, other than hopefully the avenues by which they’re going to be able to get care are going to be better,” Wellins said.

For more information about CarePartners, visit the “partner programs” section of the MaineHealth website at www.mainehealth.org, call the toll-free statewide number at 877-626-1684, or visit the Facebook page at www.facebook.com/mainehealthaccesstocare.

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Correction: July 6

In an earlier version of this article, Carol Zechman was quoted as saying CarePartners helps patients 65 and over who are not eligible for Medicare. Zechman said the program helps many patients 55 and over who have stopped working and lost insurance, but are not yet able to qualify for Medicare. Her quote has been changed to correct this reporting error.

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