The Herald Bulletin

November 17, 2013

Shelters question health center treatment of homeless

Task force official: '$25 is a lot when you have zero'

By Scott L. Miley The Herald Bulletin
The Herald Bulletin

---- — ANDERSON — Residents of local homeless shelters are being charged for medical visits to the Madison County Community Health Center despite an unwritten agreement waiving such fees, say members of a task force addressing the homeless issue.

Some residents have received bills — mailed to them in care of the shelters — seeking a $25 fee for health services, said Amy Bond, president of the Anderson/Madison County Homeless Task Force.

“Twenty-five dollars is a lot when you have zero,” said Bond.

In turn, shelter residents are seeking more expensive treatment at hospital emergency rooms where the cost can often be written off for charitable purposes, she said.

The health center, however, operates under a grant where the homeless are not turned away, said Anthony J. Malone, executive director of the center, 1547 Ohio Ave. Last week for example, he said, the center referred in-house care to nine homeless patients.

Malone cited his homeless patient enrollment at 29 in 2010, rising to 70 in 2012 and an estimated 90 this year. However, physician recruitment efforts has yielded limited ability to see more patients, Malone wrote in an email to The Herald Bulletin. He wrote, “Many problems of homeless are chronic and they need physician specialty care. Their problems are long term, life threatening and intense due to long term lack of care.”

The dilemma goes back nearly a year when a sign was posted at the health center indicating it would not treat residents of homeless shelters without payment, task force representatives said.

The task force has numerous members; shelters represented include The Christian Center, Alternatives Inc., Dove Harbor, House of Hope, and Bountiful Harvest Ministries — Beauty For Ashes Transitional Home.

Some members representing the shelters recently met with The Herald Bulletin. The representatives asked not to be identified by name because they were concerned their clients would not receive future health center services.

The center was founded in 1999 to provide primary health care to the uninsured, underinsured and socio-economic disadvantaged residing in Madison County. Current task force members acknowledge that in 2002 the health center entered into a contract with the task force that provided services to shelter residents under a $7,500 grant from the Madison County Community Foundation.

Under that agreement, the center would use a sliding fee scale to provide basic medical services including medical samples, discounted prescriptions and referrals. A key element of that agreement stated, “The homeless shelter directors do not accept any financial liability for payment of expenses incurred.”

An unwritten understanding developed by which homeless patients were to receive services without paying for them, task force representatives said.

Based on minutes from task force meetings, in February, the health center sought a $25,000 grant from the United Way of Madison County. As proposed, the health center wanted to bill the United Way for medical services involving task force agencies. However, task force members balked at the idea, saying the arrangement would place homeless people in a different category than people who were uninsured.

In March, a new memorandum of understanding from the health center was presented to task force members where funding sources, i.e. the United Way, would be sought in finding grants to cover health care services. The shelters would be responsible, through the task force, for payment of health center services. Task force members said they did not want to be part of the health center’s “accounts receivable department.”

In April, a shelter representative reported that a resident was “treated poorly” at the health center. Another task force member said a client with post-traumatic stress syndrome was seen by the center, given one month’s worth of medicine and “not allowed to return.” The task force considered contacting local hospitals to discuss how to treat clients unable to receive health center services.

In May, three of the agencies — Beauty for Ashes, House of Hope and The Christian Center — reported they had been billed $25 for individual clients’ visits to the health center.

Since then, talks between the task force and health center have stalled.

The issue now, the agencies say, is that shelter residents are choosing to go to emergency rooms instead of the health center.

In recent months, St. Vincent Anderson Regional Hospital has seen an increase in visits to its emergency room by homeless patients, said spokesman Randy Titus. However, officials cannot directly relate the increase to health center policies or practices.

A spokesperson for Community Hospital Anderson said it has not seen an increase in residents from homeless shelters coming to the emergency room.

In the fall of 2012, the United Way of Madison County met with Malone and Bob Anders, vice chair of the board of directors for the health center, to discuss the reported suspension of services for shelter residents, said Nancy Vaughan, president of the United Way.

In February, the United Way received a grant request from the health center to fund medical care for shelter residents but it was not granted, in part, because a new memorandum of understanding had not been reached.

Now, task force members say they want to go back to the original agreement for free services for shelter residents.

“What we’d like to see if the health center gets back to its purpose to provide accessible medical care to those who are underinsured and underserved, which is the homeless population,” said Bond.