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Nonprofits like PCAP are forced to fill gaps for many uninsured folks

Rusty Williams is no whiner. But she is unlucky enough to be among a growing number of Americans--and some half-million Arizonans--who find themselves without health care.

Still, her situation would be even dicier if not for the Pima Community Access Program, or PCAP, an innovative nonprofit safety net rescuing folks like her from financial ruin.

After 10 years handling phones with First Data Corporation, Williams was handed her walking papers in 2001. Toting a history of seizures and other medical problems, she suddenly found herself in a free fall. "I had medical insurance," she says, "and then the job left town, putting about 1,100 of us out of work."

She eventually applied to the Arizona Health Care Cost Containment System or AHCCCS. "I had it for about a year," she says, "and then I finally applied for disability under (federal) Social Security, and was awarded that."

But there was a catch: Meager or not, those monthly Social Security payments had nudged her slightly above the allowable AHCCCS income level, which she says was then $746. At the same time, there was also a 30-month waiting period for her to get on federal Medicaid.

"So I was taken off AHCCCS," she says, "because I made too much from Social Security. But after paying for my seizure medication, I was lucky to have $20 left at the end of the month." She was dancing the edge of financial ruin when fate intervened: One night, she was watching KUAT TV's Arizona Illustrated, when the show spotlighted PCAP.

Founded in 2001, the agency links adults with very discounted medical services, from doctor's clinics and diagnostic work to prescriptions with participating pharmacies. "We call it a bridge to health care," says Jill Bullock, PCAP's network representative. "The No. 1 cause of bankruptcy is medical (costs). This program saves people from bankruptcy."

PCAP's initial funding came from a federal grant written by the El Rio Community Health Center, in what's become a symbiotic relationship. "El Rio serves anybody," says Bullock, "people without health insurance, people with health insurance, undocumented people. But while they have primary-care galore, they didn't have a place to send their patients for specialty care."

That's where PCAP comes in, arranging for specialists, lab work, X-rays and hospitalization. It's a system built on big hearts: Hospitals offer cut-rate services, and network doctors are paid only 30 percent of Medicare rates. For example, an MD normally charging $1,124 for a hernia operation would provide the same service to PCAP members for $180. "They're making sure that the community has access to care," says Bullock. "It's really a very cool program."

To join PCAP, prospective members are screened, and their cases researched to ensure they don't qualify for any other Medicaid care. "That's when they are eligible for PCAP," she says, "provided they meet our eligibility requirements." Members must be at least 18, live in Pima County and fall under income levels that aren't indicative of pure poverty. For example, an adult such as Rusty Williams could make $23,000 a year and still qualify, as would a family of four making $48,000. "These are working people," says Bullock, "who may not be insured through their employer, which is a big problem in Pima County. Or they are people on Social Security who retired early and don't yet have Medicare benefits."

But the very service that PCAP provides also highlights a glaring problem: People like Rusty Williams often find themselves caught between state health-care programs and federal programs. "It's a common problem, and not just in Arizona," says Risa Elias, senior associate at the Kaiser Family Foundation, a health-care research institute in California and Washington, D.C. "It's even more of a problem for these people, because they really need health insurance because of their disabilities."

They aren't alone. U.S. Census data from 2003 reveals that some 45 million of us lack adequate health-care coverage. That's 15.6 percent of Americans--a jump from 15.2 percent a year earlier. During that same period, about 650,000 adults in Arizona lacked health insurance.

The reasons can include job loss, debt or chronic illness. Bureaucratic bungling can also be a factor: According to Bullock, some PCAP members say AHCCCS encouraged them to apply for federal assistance such as Social Security--sometimes leaving people like Rusty Williams with no insurance at all. AHCCCS spokeswoman Liz Olson says she's "not aware of that happening." Still, in the AHCCCS application process, "there are references to other places to get some help," she says. "I've gotten calls at the public information office from people wanting to know where else they can go."

While people applying for federal programs aren't always aware that they could be bumped off AHCCCS, "they are made aware that if there is a change in their income, that they need to report that," Olson says.

Meanwhile, neither AHCCCS nor federal assistance can jimmy the income numbers since they're set by law. That can indeed create problems, says Jim Pavletich, a spokesman for the Social Security Administration. Because of the long-term nature of disability insurance, Social Security doesn't provide health-care coverage "for the first five full months, and then Medicare doesn't begin until the 25th payment month--potentially 30 months from the point of injury or disability."

That's a long haul--and part of the reason organizations such as PCAP are critical. But this nifty little agency shouldn't be taken for granted. Now serving 6,000 county residents, PCAP is scrambling for funds and dipping into reserves to stay afloat. Meanwhile, its assistance role grows more crucial every day.

Just ask Rusty Williams.