Seven years ago, I wrote about how Mainers can access free or very low-cost healthcare for the Portland Phoenix. I was not yet eligible for insurance through my job, and I had to figure out how a person of limited means could get some care. (See "A Grim Realization," December 26, 2002.)
In a follow-up piece a year later, I added some advice for navigating the complicated bureaucracy that governs free care, and this hopeful note about a new state-run agency: "The first phase of DirigoHealth (available for small businesses, self-employed people, and workers without access to job-based coverage) should be available 'no later than October 4, 2004.' . . . The master plan is that by 2009, everyone in the state of Maine will have access to health care." (See "Don't Let Yourself Go Without Care," January 23, 2004.)
Clearly, the master plan has failed. Five years later, Dirigo has had to eliminate the portion of its program that offered consumers a sliding scale based on income, and so has been priced out of the range of the people who need it most. And it's so low on cash that it is no longer accepting new members; not a good sign. MaineCare, the state version of Medicaid, which in 2002 opened its doors to poor adults without a disability between the ages of 21 and 64, now carries a waiting list of more than 8000 uninsured adults in that category. Even CarePartners, a local non-profit that works with area health providers to offer volunteer services, has a waiting list of nearly 200 people.
But don't despair; there are still options available for people without coverage. And as Kate Herrick, program administrator for CarePartners, was careful to emphasize, waiting lists open up, funding becomes available, and opportunities do arise ? but you need to be in a position to act on them; you need to be in the system.
Here is a list of resources, and a step-by-step process for accessing care, with two caveats: First, if you are of limited means financially, you must be administratively diligent. Make copies of your annual tax returns, keep all of your pay stubs, and pay attention to re-application deadlines and paperwork. Second, you may have to face down those demons who suggest (sometimes publicly, at town-hall meetings) that seeking healthcare through the state is for freeloaders or communists. For people of any background, getting help, especially through social-service programs, can bring up some challenging emotions ? internalized demons, if you will. Ignore them. Everybody should have access to health care. Anyone who thinks differently should be regarded as if they are speaking in tongues.
What you need to know
All of the programs that offer free or low-cost coverage are based on Federal Poverty Guidelines (FPG), which are updated at the end of January each year. The numbers used in this article are based on guidelines for a single adult, age 21 to 64; adults with disabilities and/or dependents qualify for greater assistance. Income in relation to these guidelines (and the services you will be eligible for) is calculated in percentages: if you earn $10,830 per year (that's $902.50 per month), you are living at 100 percent of the FPG. (If you earn more than that amount, you won't qualify for MaineCare; however, it is smart to apply anyway, for reasons I will outline below.)