The frail, elderly poor get good health coverage -- if they're poor enough to qualify for it and patient enough to wait.
The coverage is Medicaid. The problem is that you have to be very poor to get it -- a single person can't have monthly income greater than $620 -- and it takes months for services to start. In the meantime, the elderly often do without a personal-care aide or pay scarce dollars for prescription drugs.
Case managers for the elderly say some applicants last year waited six months to get services.
"Six months was a best-case scenario," said Deb Seifert, project coordinator at Concerned Ecumenical Ministries, a contract agency for elderly case management. "Meanwhile, (the elderly) have to manage with inadequate help."
Cheryl Buttino, project coordinator for the Kensington-Bailey Community Center, said the only way to speed things up "was to scream at the (Medicaid) examiner or call for a fair hearing (with a judge)."
Social service administrators blamed the lengthy delay on a temporary manpower shortage. "We're in much better shape now," said Christine Bush, the county's assistant deputy commissioner of social services. "Total processing time is three months at the outside."
But caseworkers say even a three-month wait is too long for elderly in need of a home-care aide or other help.
"It's not like they're waiting for money to pay a bill or something," said Buttino.
"There aren't enough Medicaid workers to process all the paperwork," said Seifert.
Bush said the department's five Medicaid examiners process about 25 new cases a month, which she called a "reasonable" caseload.
The problems go beyond the wait for services. Elderly living at home and applying for Medicaid face mounds of paperwork and often have to pay hundreds of dollars to prove their eligibility.
Applicants must show the previous three years of bank statements, with documentation for any transaction over $1,000.
"People don't save these things, or they can't organize them because they can't see," said Seifert. "You have to get birth certificates and have doctors' forms filled out. It's a formidable process if you're not feeling well.
"People ask me, 'Why do I have to go through this just to have someone give me a bath?' One man told me recently, 'I'll just go out and lay in the snow.' "
The cost of getting bank statements can run into hundreds of dollars, money some elderly poor don't have.
"We have people eligible (for Medicaid)," said Buttino, "but when the bank tells them what it costs for the statements, they say, 'No, I can't pay that.' "
Bush said the statements are needed to prove people didn't shed assets to qualify for Medicaid.
Few complain about the coverage itself, once they get it. Elderly poor on Medicaid get benefits that help keep them in their homes and out of a nursing home, which is more than three times as costly as in-home care.
Odell Kea, 89, a lanky ex-steelworker, gets daily visits to his East Side apartment from a home-care aide who cooks, cleans, shops for groceries and helps him bathe. Medicaid also covers weekly visits to an adult day-care center, where Kea eats lunch and mingles with other seniors.
Other services normally covered by Medicaid include prescription drugs, hearing aids, dentures and transportation to medical appointments.
"It's very comprehensive (coverage)," said Bush. "Often more comprehensive than some private insurance companies."
Medicaid coverage is so good that many elderly not poor enough to qualify for it pay to get it. Those over the Medicaid income maximum -- $620 monthly for single people, $895 for couples -- can "buy in" by paying the difference between the Medicaid income limit and their monthly income. A single senior living on a $750 monthly Social Security check, for instance, could pay $130 a month to get Medicaid coverage -- and the home-care aide or adult day care they might not be able to otherwise afford.
"By paying, say, $100 or so a month, they may get $1,000 worth of services," said Darold Conklin, case supervisor with the county's Department of Social Services.
About 75 percent of the county's 2,600 in-home elderly Medicaid recipients "buy into" the coverage by paying the difference between their monthly income and the Medicaid limit.
But some elderly poor who are over the Medicaid limit can't afford to "buy in." These "near-poor," to use the state's euphemism, instead are eligible for less-comprehensive coverage called EISEP (Expanded In-Home Services for the Elderly Program), which is funded mainly by the state. Many EISEP recipients pay part of the cost of coverage, depending on their income, with those receiving more than $2,000 a month paying full cost.
But the EISEP budget is limited, which means the 350 elderly covered countywide sometimes wait months or years for a personal-care aide or other services.
"We have (elderly) people on a (EISEP) waiting list for services for two or three years," said Deborah Harris, director of the Kensington-Bailey Community Center.
"EISEP is a grant-funded program," said Patricia Watson, supervisor of case management services for the county's Department of Senior Services. "When we're out of money, we're out of money."
Which leaves many "near-poor" elderly waiting for help.
News Staff Reporter Paula Voell also contributed to this story.