Expanding Buncombe’s health-care safety net

How can Buncombe County expand health-care services to low-income, uninsured residents?

It’s a question the county’s health-care community has long addressed—and had several notable successes in tackling. But with demand pressures increasing every day, there’s a new urgency among local leaders who are working on plans that could dramatically remake the safety net of services for residents who don’t have access to health insurance.

In a presentation to the Buncombe County Board of Health on Sept. 18, Assistant County Manager Mandy Stone explained two possible paths local officials could explore: a system to offer limited Medicaid benefits to a greater number of people, or one that would expand services by getting matching federal funds through a special Medicaid waiver. Medicaid is the federal health-care program for low-income families and individuals.

Stone said she’ll ask Buncombe County commissioners to approve continued study of the matter, which would be led by consulting firm Health Management Associates, a group that the Asheville Area Chamber of Commerce and Mission Hospitals hired a year ago “to tell us how to maximize our resources.”

Over the past year, the consultants have gathered data and looked at the local structures in place to serve the uninsured. Stone stressed that no decisions about possible changes have been made, and that working the state and federal governments on the issue would be a long process.

Curtis Venable, an attorney with Pisgah Legal Services in Asheville, a nonprofit organization that works with low-income clients, has been following the discussion and said it’s still in a formative stage.

“Buncombe County has the resources—the cash is there,” he said. “You can take that cash and multiply it and we can help more people. That’s volume one. Volume two is do you set up a system that runs everyone through a federally qualified health clinic, or set people up with another Medicaid card to get limited coverage for the group of people 19 to 64” that need coverage.

Venable said the difficult local discussion will have to focus on deciding eligibility rules and what level of care to offer. Other communities that have tried similar ideas have been forced to drastically scale back offerings because of the costs involved, he said.

Stone said Buncombe County spends about $4.5 million a year on primary care for residents at the Buncombe County Health Center and on Project Access, a program in which local doctors donate their services to treat people with no health insurance. About 20 percent of Buncombe County’s population of 222,000 has no health insurance, according to Stone.

There are other local efforts aimed at addressing the issue of providing health care to the uninsured. One group of health-care organizations is examining ways to provide preventative screenings to make sure people with chronic diseases get treatment. It’s also studying the idea of establishing a community pharmacy and a tracking system that would share information on patients and reimbursements.

The Asheville Area Chamber of Commerce, meanwhile, has a group studying ways to help small businesses provide health insurance for their employees. The Business Health Care Roundtable worked with state lawmakers and crafted a bill to create a health-insurance pilot project in Buncombe and surrounding counties. The goal is to reduce the number of uninsured workers and reduce costs for small businesses providing that health insurance. The legislation was referred to a committee of lawmakers in May for more study.