Taking care of the county, one kid at a time

For many Blazers, receiving a vaccine or a shot offers a permanent peace of mind. For sophomore Yesli Leon, receiving the swine flu vaccine in late 2009 meant only a temporary respite from worry.

Leon is one of the many students at Blair on government-funded health care. She receives health coverage from Medicaid, one of the public health insurance options available for students in Montgomery County. Public health insurance functions in much the same way as private health insurance: The insurance provider pays for all or part of a member's doctor's visits, hospitalizations and medications, greatly reducing the cost of health care. There are differences, though: People with private insurance can choose from a bevy of companies, such as State Farm or Blue Cross. In return for a monthly fee, the company helps to pay for certain medical expenses. Public insurance is free for members, and state and federal governments foot the bill. Not everyone can sign up for public insurance, though — it's need-based, so only certain sections of the population qualify, like pregnant women, the elderly, the blind and dependent children up to age 19 in low-income families. This means that many Blazers are eligible — even if they don't know it.

Assuaging their fears

Leon and her mother were not sure whether they would qualify for public health care when they arrived in Montgomery County in November 2009. Her mother applied for Medicaid through the mail and finally received the acceptance letter about a month after they moved. Leon says she has been to the doctor three or four times with her family since they first got coverage. Even though she has had the shots and vaccines she needs, she is worried. Her mother is not sure when Leon will no longer be covered by the family insurance and will have to find her own. Leon talks often with her mother about her unclear future and fears contracting a severe illness whose treatment Medicaid would not cover.

Karen Shilling, one of Leon's teachers, says that her students often come to her with health care questions. Shilling teaches English for Speakers of Other Languages (ESOL), and she says that many of her students don't know where to get medical assistance in the United States. When they ask her where to go to alleviate the pain of incoming wisdom teeth or to get the shots they need, she refers them to the school nurse, Debbie Bitonti. Bitonti then works to find health care services to meet the student's needs. "The nurse follows things through [until] the end," Shilling says. "I think we have a wonderful nurse; we're really lucky."

Whenever a student enters the health room with more than a slight fever or a headache, Bitonti is ready. If a student requires further medical attention than can be provided in the health room, Bitonti says she makes their health care situation her business. When a student reveals that they don't have health care, Bitonti provides them with forms to apply for the Maryland Children's Health Program (MCHP), a state-funded health insurance program, or Care for Kids (CFK), a county-run preventative health care plan. Bitonti also distributes information about community clinics.

A program for every place

Even with such a support system, some students fall through the cracks. Uninsured freshman Yenifer Rosario went to the nurse with a toothache earlier this school year. She says Bitonti gave her information about Montgomery County clinics. Many of these clinics operate on a sliding scale, meaning they charge patients based on their income level, and Rosario's parents could not afford the $50-$80 charges the clinics required. Rosario says the school offered her financial aid, but she never received it. Rosario has not seen a doctor since she arrived in the United States in August 2009.

For students like Rosario, applying to one of the county or state public health care programs can be a better option. Last school year, the Blair health room distributed forms to 300 inquiring students. Bitonti and other health room staff offer to work with families so they can apply for the programs that best suit their needs. Once a student and his or her parents complete an application form, they either mail it in or head down to the Service Eligibility Unit (SEU) in Silver Spring, a part of the Montgomery County Department of Health and Human Services. The SEU picks up where the health room staff leaves off. SEU staff work with families to ensure they can receive the best free coverage available to them, says Sharla Quintanilla, program manager at the SEU. "In doing these applications, our staff knows how to ask certain questions about the household to know what applications [the family] should be filling out," she says. After the student's family submits the form, the SEU staff decide in which program to place the student based on his or her household size, citizenship status and income level.

Students are often placed into one of three programs: Family Medicaid, MCHP or CFK. A student qualifies for Family Medicaid if his or her family is low-income and if all members are legally citizens of the United States, like in Leon's family. Like Medicaid, MCHP requires that its members be legal citizens below 200 percent of the federal poverty level, but only provides coverage to children, not entire families. "MCHP is for families where mom and dad don't have legal immigration status, but the kid was born here," explains Quintanilla, as an example. Unlike MCHP and Medicaid, CFK admits applicants under 250 percent of the federal poverty level, and citizenship is not considered. Annually, the SEU places 10,000 people in county healthcare programs and 40,000 people in Medicaid, says Quintanilla.

While MCHP is an insurance program that operates in the same way as Medicaid — the government pays for check-ups, sick visits, some hospitalization, emergency room visits and some specialty care at certain doctors' offices — CFK is what Marisol Ortiz, CFK Program Manager calls a "preventative" program, not insurance. This means that CFK does not cover hospitalization, emergency room visits or specialty care, and patients cannot pick their own doctors. "We enroll them with a medical provider and we provide them with well visits, sick visits and we provide some medication," says Ortiz. "We look at their geographic area to see [which] provider is closest to the home to facilitate how they get there." Currently, there are 50 students at Blair enrolled in CFK, says Ortiz. These students visit one of a variety of private practices, public clinics and school health care centers, all of which have the staff and equipment necessary to perform physical exams, lab work, vision and hearing screenings and follow-up care. Ladys Lux, the school nurse at Broad Acres Elementary School's health center, assures, "There always will be some kind of treatment here."

Last resort

Without the assistance of clinics or a county program, finding treatment can difficult. Rosario applied for CFK in September 2009. Even though Rosario's parents knew their daughter would be ineligible, as they earn over 250 percent of the poverty level, they completed an application. Quintanilla says it is rare for a family to apply for a program for which they know they will not be approved. "We try to explain to people. We have brochures at our centers that tell people what the baseline eligibility units are. People make decisions based on that," she says. But Rosario's parents applied to CFK as a last resort. With no insurance, it is too expensive for Rosario's family to seek treatment for her dental or vision problems.

Quintanilla explains that it's common for families to fall short of eligibility requirements but still not have the money to pay out of pocket for health care. She says that sometimes even those families on public health insurance cannot receive the care they need. "I worked in the [clinics] and I saw people who were underinsured. Maybe they have insurance but the deductible is $10,000 and they can't pay it, or their insurance maxes out at five visits," she says.

Despite difficulties, Shilling knows that her students are grateful for any health care they can receive. She urges her students to attend free health fairs when they occur and to visit clinics if they have a health problem. "I don't give medical advice, but I give 'mommy' advice — I'm a mom," she says. For this mom, Montgomery County is a place she hopes her 'kids' will be safe.

CFK's four school health care centers at Broad Acres, Harmony Hills, Summit Hall and Gaithersburg Elementary Schools all provide the same services as regular doctors' offices. "Here, it's like having a clinic," says Lux. Every center is open during school hours and is staffed by a school nurse, school health technician, nurse practitioner and visiting doctor. Although it provides basic medical care, the center cannot provide specialty care. Lux explains that the center refers children in need to specialty doctors, but children do not always receive treatment. "Sometimes what happens is that they don't use the doctors, so [follow-up] is a way to link them to the doctors," she says.