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Helping those who fall through health-care access cracks

Presbyterian Medical Care Mission

 A recent survey by the Texas Medical Association only reinforced what many poor people in need of health care already knew.

The survey showed that only 31 percent of Texas doctors are accepting new patients who rely on Medicaid, the health insurance for the poor and disabled. In 2000, that number was 67 percent, according to the survey.

Perhaps no one knows that figure better than Scott Golding, executive director of Presbyterian Medical Care Mission, a local clinic that serves poor people. Golding said he is seeing a whole new population of people coming to the clinic.

"They have coverage but they don't have access," he said. "Coverage doesn't equal access."

But thanks to individual donors, churches, foundations, and some governmental funding, Presbyterian Medical Care Mission will be celebrating its 30th year in 2013. Many people who fall through the gaps, either in coverage or access, find help at the clinic.

Presbyterian Medical Care Mission, located on Pine Street across from Hendrick Medical Center, has two full-time physicians on staff, one full-time and one part-time physician assistant, and one full-time pharmacist who can write prescriptions. Golding said he is working to add another full-time medical provider.

In addition, the clinic contracts with some physicians in the community for referrals. Golding isn't pointing fingers in the conversation over the low percentage of doctors who will take new Medicaid patients.

He understands that physicians have to make money to keep their office open, and he understands the paperwork involved in treating Medicaid patients. He feels blessed to have the support he does in Abilene.

"Our network is as strong as it's ever been," he said. "They (doctors) are certainly very responsive to helping us out."

Poor people in Abilene who lack either insurance coverage or access to a physician aren't left alone to fend for themselves. Several nonprofits, in addition to Presbyterian Medical Care Mission, can help. And all report increasing demand.

Golding said he expects an increase this year over the 9,500 to 11,500 patients seen in the past at Presbyterian Medical Care Mission.

"We're going to be right at 15,000 this year," Golding said, and he expects that to rise another 1,000 in 2013.

Other nonprofits report similar expectations. Carla Holeva, interim chief executive officer with Planned Parenthood of West Texas, said 2,500 patients visited the Abilene location in 2011 and the numbers are on track for at least that many this year.

Fees at the clinic are income-based, but Holeva said women who qualify can receive health service for free under the Texas Women's Health program.

State funding for that program is uncertain, she said. Even if funding decreases, women who can't afford services will be seen at the clinic, Holeva said.

"We do not turn women away," she wrote in an email. "We try our best to work with them on payment."

The Alliance for Women and Children, formerly the Young Women's Christian Association, also offers health services for women ages 18 to 64.

D'Nette Broyles, manager of the Alliance's Women's Health Awareness program, said 1,095 women came to the Alliance for assistance in 2011.

The Alliance, through contracts with hospitals and physicians in the community, offers a full range of women's health services, Broyles said.

Broyles said 1,100 to 1,200 visits per year has been typical in the past, but she sees that number rising.

"We anticipate by the end of the year it's going to be more than that," she said.

The Alliance gets funding from foundations, its own fundraising, the United Way, and the Department of State Health Services. Funding details from the state for 2013 are still being worked out, Broyles said.

As health care at both the state and national level remains uncertain, more people are likely to turn to nonprofits and faith-based institutions for help. Golding, head of Presbyterian Medical Care Mission, is grateful for the assistance the clinic receives from the community.

The mission opened in 1983 in a small room at Sears Recreation Center and now has its own facility, which is donated by Hendrick Medical Center.

According to its website, the mission was the vision of local leaders, including Dr. Fred White, who approached a group of elders at First Central Presbyterian Church. They agreed to help him gather the resources to start the mission. A dental clinic was added in 1999.

Locally, the mission gets some funding through Taylor County and a medical assistance program operated by the Abilene-Taylor County Public Health District.

Taylor County Judge Downing Bolls said the relationship with Presbyterian Medical Care Mission has been beneficial to the county. The county is mandated by the state to set aside 8 percent of its general tax levy for indigent health care and also is responsible for inmate health care at the jail.

Funding for indigent health care for the current fiscal year is $1.85 million. Bolls said Presbyterian Medical Care Mission currently is funded for $395,850 and is requesting $405,850 for the next fiscal year.

Bolls said counties do not receive any state money for indigent health care or for inmate health care, which makes partnering with a clinic like Presbyterian Medical Care Mission a plus for the county.

"The medical care mission has been a good fit for the county and its taxpayers," Bolls wrote in an email. "They provide an extremely effective alternative to traditional medical care."

Bolls noted that included in Presbyterian Medical Care Mission's budget request is $85,000 for an additional health care provider.

"I think the fact that they are requesting another provider this year is proof that the need is there," he wrote in an email.

All the proof that's needed can be found in a visit to the clinic. Golding noted that the clinic has to turn away 40 to 50 people a day because of increased need. But, he said, they will be seen as soon as possible.

From the beginning, the emphasis has been on the mission of the medical care mission. Golding said this has been the toughest budget year he has seen, but that providers and donors seem to rise to the meet the need.

"It just takes more every year," he said, "to keep up with the demand."

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