While those speaking about Medicaid expansion typically have a conversation couched in terms of the conditional “if,” the Shared Care Free Clinic's former medical director Bridget McCandless prefers to speak in a more definite tense.
“When Medicaid expansion occurs, a lot of our patients won't be seen here anymore,” she said referring to the stalled Medicaid expansion packaged with the Affordable Care Act.
An expanded Medicaid program would cover single parents and childless adults who earn up to 138 percent of the poverty level, about $25,000 for a family of three.
The Missouri Medicaid Alliance, a group advocating for expansion, estimates broader Medicaid could cover as many as 260,000 of the state's 877,000 uninsured.
McCandless said there are about 50,000 potential beneficiaries in Jackson County alone.
“There's an awful lot of work that will go around this, and we're having a more politically productive conversation,” one that she expects will result in Medicaid expansion in 2015, McCandless said.
McCandless said the clinic's board of directors felt strong enough about the possibility that they felt it will be more beneficial to match their patients with other area health care providers and end operations in Independence rather than hire a replacement for McCandless – who has taken on the role of President with the Health Care Foundation of Greater Kansas City – for the year it would take to craft the right legislation.
“We could have chosen to remain … but we need to help our patients get into a position where they can be enrolled when the time comes,” she said.
The Shared Care Free Clinic of Jackson County ended its 14 years of service on Tuesday.
While the clinic stopped accepting new patients in August, McCandless said she and her staff have been working hard to place its 300 patients with new providers.
At its peak, the clinic was serving close to 700 patients from uninsured and impoverished populations. The clinic was a primary health care provider for more than 2,000 area residents.
McCandless said the clinic was building substantial partnerships with area clinics serving similar patients, each of which is in a position to accept the patients that relied on Shared Care Free Clinic. None of those clinics is in Eastern Jackson County.
The clinic's extensive services, which ranged from primary care to lab services, was designed specifically for chronically ill patients, a population that often requires consistent access to critical and costly medications. Often, McCandless said patients were juggling illness with employment instability and mounting medical debt. She offered the example of an uninsured diabetes patient faced with a $500 charge for a three-month supply of insulin.
McCandless might be less sure her former patients will see relief in the future through state action if she hasn't already seen it with the Affordable Care Act's initial actions. She said the clinic's under-26 population dropped to just 3 percent from 18 percent once they were allowed to remain on their parents' insurance policies. A number have also found coverage through the health insurance marketplace.
“Unfortunately most are in the Medicaid gap,” she said.
While the gap remains, McCandless said she hopes to provide leadership for the health community and advocacy for Kansas City's underserved populations.
“It's the same thing we spent all our efforts on here except instead of being just Independence, we're going to be working with all six counties in the metro area, and facilitating other people to do the same work,” she said.
Uninsured patients can still access health care at the following area providers:
Mission of Hope clinic 6303 Evanston Ave. Kansas City, MO 64133 816-356-4325
Kansas City CARE Clinic 3515 Broadway Blvd. Kansas City, MO 64111 816-753-5144
The Medina Clinic 13013 Fuller Avenue, Suite A Grandview, MO 64030 816-326-0990