By Catherine Keightley
Across the Rockbridge area, nearly 23% of the population relies on Medicaid and an estimated 5% are uninsured. For many residents, federally supported clinics play an important role in filling gaps in the health care system.
Some residents have already lost insurance subsidies, and local officials say upcoming federal policy changes could cause others to lose Medicaid coverage later this year.
The Rockbridge Area Health Center serves more than 9,000 patients each year, with 41% relying on Medicaid, according to the center’s data. The center also offers “sliding-fee” discounts to make care more affordable for uninsured and underinsured patients.
Now, a new practice in Lexington is trying a different approach. River Ridge Family Health, which has started offering telehealth services and plans to open a physical space next month, uses a direct primary care model. Instead of billing insurance for visits, patients pay a monthly membership fee that covers primary care services.
Elizabeth Berry, a nurse practitioner who owns River Ridge, said the practice hopes to provide another option for residents, regardless of their insurance status. The goal, Berry said, is to give patients more time with their provider and to offer quicker access to care.
“We can see people that don’t have insurance and people that do,” Berry said. “We have a lot of people that live out in the county that don’t have insurance, so we’re hoping to reach those people.”
Offering more affordable health care options
After a one-time enrollment fee of $100 for an individual and $200 for a family, patients will join a plan and pay a monthly rate. They will be able to access unlimited care for that month. If they do not want to continue care for the next month, they can cancel the membership.
Berry, who has worked in health care for over 15 years, said she decided to open the practice after experiencing frustrations with larger health care systems.
“There’s just a running theme of wanting to push patients through,” Berry said. “We are forced to see more people and spend less time with them, which ultimately leads to poor outcomes.”
River Ridge will offer similar services to a traditional family practice, including wellness visits, chronic disease management and acute illness care. Berry runs the practice on her own but said she may hire additional staff if the patient load increases.
“Direct primary care is basically being able to spend more time with people,” Berry said. “The big push is access.”
Berry said she is launching her practice at a time when many patients in the Rockbridge area struggle to schedule appointments on time with primary care providers. She said she hopes to help residents who may not have other options for care.
“A lot of patients are having to wait several weeks to see their primary care doctor because they’re booked,” Berry said.
The access challenges can be attributed to the county’s already complex health care landscape. Some residents aren’t eligible for public programs or struggle to navigate insurance systems, gaps that Berry said she hopes her clinic will address.
Rockbridge Area Health Center, which receives funding from federal grants, offers discounts called sliding fees for uninsured patients based on income. But the center has not seen increased funding even though the demand for the discounts is growing.
“There is definitely a resource strain,” said Mary Looney, the chief operating officer of RAHC.
Hundreds of Rockbridge County residents recently lost subsidies that helped them afford insurance plans through the Affordable Care Act marketplace, according to health center officials.
When patients lose insurance coverage, the health center continues to serve them, though officials said the situation creates financial and operational challenges. Residents who lose insurance also may not realize they still qualify for other financial assistance programs.
“Some people just won’t ask for help,” Looney said. “They just figure they lost it.”
Federal policies could impact health care access
Medicaid applications in the county have remained relatively steady in recent months, according to Rockbridge Department of Social Services officials. But upcoming federal policy changes could affect eligibility for some residents.
Dinah Hupman, director of the Rockbridge Area Department of Social Services, and Holly Deacon, the benefits program supervisor, said potential work requirement changes for Medicaid expansion recipients could impact adults ages 19 to 64 who do not qualify under other eligibility categories.
Medicaid expansion recipients are low-income adults who gained health care coverage after the Affordable Care Act expanded eligibility for the program. If the adults earn up to 138% of the federal poverty level, they qualify for the insurance, which millions of Americans use.
The policy changes, scheduled to take effect at the end of the year, would require many adults enrolled through Medicaid expansion to report at least 80 hours per month of work, education or community service to maintain coverage.
The Joint Economic Committee, a Congressional committee that oversees economic growth in the U.S., said that over 180,000 Virginians could lose coverage due to this work requirement provision, which is 32% of all adults currently using the Medicaid expansion coverage.
River Ridge’s owner said she hopes to maintain a smaller patient panel of about 200 to 300 people so she can dedicate enough time for each patient. Berry also said building the practice will take time because it is a relatively new model, especially for rural communities.
“Anytime there’s something new,” Berry said, “there can be resistance.”