MIDDLEBURY — Leaders of the Open Door Clinic (ODC) in Middlebury are trying to fill a $62,000 budget shortfall that could have a dramatic impact on the nonprofit’s efforts to extend medical care to migrant farm workers and connect some Addison County residents to health insurance.
The $62,000 shortfall includes the loss of $12,000 in state funding for the ODC’s lone, part-time health care “navigator” who helps uninsured and under-insured Addison County residents find coverage through Vermont Health Connect. That navigator, Melanie Clark, largely assists residents who are unable — due to literacy, language and/or comprehension issues — to negotiate the Vermont Health Connect website, which features a plethora of plans.
“We serve all community members, especially the most vulnerable in our community; uninsured, employed individuals with low literacy skills, who generally come from low socio-economic backgrounds, have mental health issues or can’t speak English,” said Clark who has been an ODC navigator for several years. “For these individuals, our services are invaluable.”
Some clients have said they would have gone without insurance or let their insurance lapse had they not had the assistance of the clinic’s navigator, according to ODC officials.
But the biggest financial hit to the ODC comes with the scheduled sunset next April 30 of a grant from the federal Health Resources & Services Administration (HRSA). The grant has given the ODC $50,000 in each of the past nine years to deliver health care to isolated migrant workers who are an increasingly essential part of the Addison County agricultural workforce. Specifically, the HRSA grant has helped the clinic fund an outreach nurse and a patient services coordinator who are well-versed in Spanish, according to ODC Executive Director Heidi Sulis.
For larger health care organizations, a $62,000 loss can be backfilled. But the $62,000  in question represents 18 percent of the ODC’s total operating budget of $354,000. And the clinic is not allowed to charge for its medical services, donated by local health care providers.
Still, Sulis said the clinic will try to maintain the navigator/migrant worker services that so many have come to depend upon. In 2016, the ODC held 91 clinics, saw 829 unduplicated patients (including 368 new patients) and provided 1,145 medical visits and 136 dental procedures. Its Vermont Health Connect navigator (Clark) enrolled 202 individuals into a health insurance plan and logged a total of 908 health insurance interactions with community members. The clinic launched a new dental program and visited 30 local farms at which 244 farmworkers were vaccinated in the field.
Many of these workers now have chronic diseases, according to ODC officials. Absent clinical care, many would likely delay care until they become very ill, or have to use urgent care and emergency rooms.
“We will do everything we can to deliver the services we are delivering right now,” Sulis said. “It will depend on successful fundraising and grant writing.”
The Department of Vermont Health Access has been gradually ratcheting down its navigator grants as more people have become integrated into the state’s health care system. In 2013, there were four full and part-time Navigators in Addison County. State funding for health care navigators was initially $24,000 per year, a sum that decreased to $12,000 last year and was completely phased out this past June 30, according to Clark. At that point, Clark’s position became redefined as a “certified application counselor.” As such, Clark — now working exclusively on the clinic’s dime — primary ensures the county’s most financially strapped citizens find the best coverage. Clark these days has been fully booked during her 20 hours a week at the clinic.
Certified application counselors receive no state funding and are primarily staffers of local health care organizations who have assumed this extra role to help their patients find quality health insurance.
Many free clinics across the state have already elected to limit their health insurance counseling to their low-income clients. The ODC is hoping to avoid that step, however.
“We are trying not to exclude the general public,” said Clark, adding, “I feel this is a service the state should be funding.”
A list of “in-person assisters” available at area health care organizations can be found at tinyurl.com/yb9nz5fu. But again, many of those assisters are only available to help their respective organization’s patients.
Seán Sheehan is deputy director of the health access eligibility and enrollment Unit for the Department of Vermont Health Access. In an email exchange with the Addison Independent, Sheehan outlined the evolution of what he called the “In-Person Assister Program” since the advent of the Affordable Care Act and Vermont Health Connect:
“In short, (the program) has certainly evolved over the past five years, changing in response to federal and state funding availability as well as to program needs and the needs of Vermonters at various stages of the program,” he said. “The first couple of years focused on helping folks with private insurance transition into the marketplace, while the major lift of the subsequent couple years centered around helping Vermonters on Medicaid transition into the new system. Now that most people who need to be in the marketplace are in the marketplace, the focus can be on supporting these members with their changing needs, as well as engaging the smaller stream of people who move into the state or have had employment changes or other changes in the way they need to access health coverage.”
Sheehan, during a phone interview Wednesday morning, promised no Vermonters will be left out of the process. He said the Vermont Health Connect website (info.healthconnect.vermont.gov) includes a customer support center (toll-free 855-899-9600) and help for people who speak different languages. Moreover, he said the Department of Vermont Health Access, upon request, will try to pin down one-on-one navigation counseling to people who can’t find such help in their county.
Clark has found that her clients have become the best advertisers for her service. It leads to referrals, which in turn has prevented some Addison County residents from accidentally becoming uninsured.
“Navigators have largely contributed to the large number of people becoming insured,” Sulis said.
The ODC has tried to recruit volunteers to serve as navigators, but the complexity of the system and the highly-technical nature of position has made it tough to recruit and retain people, officials said.
It should also be noted that open enrollment for Vermont Health Connect will begin as usual on November 1, 2017. However, it will close on December 15, 2017 this year instead of at the end of January, according to Vermont Coalition of Clinics for the Uninsured (of which the ODC is a member). So Vermonters who are accustomed to having a 90-day enrollment period will only have 45 days to do so this year.
Anyone wishing to help the ODC should contact the clinic at 388-0137.
Reporter John Flowers is at [email protected].