UPDATE Don’t let yourself go without care BY TANYA WHITON

A little over a year ago I had my first foray into the complicated bureaucracies that govern access to healthcare for single low-income people (see "A grim realization," Dec. 27, 2002). In the essay that resulted, I discovered my own resistance to seeking assistance, and found some tools for getting over it: When it comes to health care, many of us still operate according to the idea that "charitable" programs (from free care to sliding scale care) are for "people who really need them."

Fact: Everybody needs health care. And there are fewer and fewer jobs that provide affordable benefits, especially for Mainers, many of whom (like myself) cobble together several part-time jobs to make ends meet. The good news is, there are options. The bad news is, you’ve got to learn how to navigate an often confusing and convoluted system in order to exercise them.

In my previous article, Nate Nickerson, director of Portland’s Division of Public Health, responded to a question about the chances of a universal system of health care with a weary sigh, saying, "I don’t know how to give you the odds." Since that time, a statewide healthcare initiative has been launched: The first phase of Dirigo Health (available for small businesses, self-employed people, and workers without access to job-based coverage) should be available "no later than October 4, 2004," according to the Consumers for Affordable Healthcare (CAHC) Web site (www.mainecahc.org). The master plan is that by 2009, everyone in the state of Maine will have access to health care.

But in the meantime, things are still strictly DIY. You’ve got to tap your inner bureaucrat to do it, but you can keep yourself healthy, and peace of mind is worth the forms and phone calls.

So, here are updates on low-income healthcare options, and some suggestions for how you can make the system work for, rather than against, you. Note that income guidelines for the following programs will be updated again in mid/late February.

Department of Human Services, (207) 822-2000. MaineCare is government-funded and free. Income cutoff for a single person: $8980 annually ($748 per month). Bring identification and proof of income. If you are rejected, tell your caseworker you want to apply for uncompensated care (now called free care). Reapply every six months. You can also apply over the phone by calling CAHC at (800) 965-7476.

Maine Medical Center, (207) 871-2433. Free care is hospital-supported, with access to the lower-cost hospital pharmacy. Family-practice centers affiliated with the hospital provide more personalized care. (I use Falmouth Family Practice, and have had excellent experiences with the staff there.) Income cutoff for a single person: $15,504 annually ($1292 per month). Bring identification, proof of income, and MaineCare rejection letter from State of Maine. Reapply every six months.

CarePartners, (207) 842-7000. CarePartners works with area providers to offer volunteer services (for a minimal co-pay), pharmaceutical benefits, and a care manager. (This means there is someone available to help you with continuity of care). Income cutoff for a single person: $15,720 annually ($1310 per month). Bring identification and proof of income.

An important change at CarePartners: Their services are now available to people who do qualify for job-based coverage but cannot afford the premiums. If your insurance costs more than five percent of your monthly gross, you may be eligible.

Portland Community Free Clinic, (207) 874-8982. The free clinic has an all-volunteer staff, providing free office visits, and a sliding scale for diagnostic tests, X-rays, and hospital-related services. Income cutoff for a single person: $17,960 annually ($1496 per month). Bring identification and proof of income.

Getting care in the first place is a hurdle. But once you’re over the initial application process ¾ based on my experiences of the past year ¾ there are a few things you can do to make managing your own healthcare a little easier.

First, when you do your taxes, make several "send out" copies of your forms: Proof of income is something you might as well get used to providing, and this eliminates a step in the reapplication process. Second, always tell the person handling your billing exactly what program you are using, and if you are using CarePartners, make doubly sure the doctor you’re seeing is one of their providers. Otherwise, you might get a bill you can’t afford to pay. Third, fill out forms and mail them the day after you receive them in the mail. Any missed connections or unconnected dots can create problems down the road.

Kathleen Durost, Resource Specialist for CarePartners, adds the following advice: "Write down the name, date, and what you talked about [whenever you make a call regarding healthcare]. Keep a notebook ¾ get organized, know who you’re talking to. Ask a lot of questions. The hardest part is asking ¾ but [you’re] the only one who can advocate for [yourself]."

If you don’t make a lot of money, anything that makes you confront this fact (sending out proof of income, informing receptionists of income-based services you are using, filling out forms) is ripe for avoidance. So, maybe you ain’t no Rockefeller. But there’s no reason for you not to have healthcare. And keep in mind that the organizations mentioned here want to help ¾ just make the call.