On Friday morning, Lilia Pineiro was finishing up an appointment for lab tests and an ultrasound to keep her diabetes and high blood pressure in check — all at no cost to her.
The round-faced 62-year-old, originally from Mexico, makes about $200 a week cleaning houses, so she can’t afford health insurance. But for the past five years, she’s managed to obtain regular treatment from the Light of the World Clinic in Oakland Park.
“I don’t know where I could go if they couldn’t help me,” Pineiro said in spanish, with a long sigh. “It would be very difficult.”
In June, Florida Gov. Rick Scott vetoed $9.5 million in funds that had been set aside for the Florida Association of Free and Charitable Clinics, and Light of the World lost nearly 10 percent of its annual funds.
Sandra Lozano-Barry, the clinic’s executive director, knew what that meant: longer waits for patients, less access to care and a scramble to fill in the gaps for people too poor to obtain health services any other way.
“It’s asking us to make gold out of straw,” she said, describing how the budget cut has already affected her health center. “And I’m not Rumpelstiltskin.”
In 2014, the state had set aside $4.5 million for free clinics. A total of 69 clinics received grants out of the funds, which were administered through the state health department. Earmarked for capacity building, the money went toward efforts to modernize technology, update equipment and add support staff, clinic directors said.
For a clinic in Homestead, the money went to updating computers and switching to electronic health records, which helped serve clients faster. In downtown Miami, a clinic affiliated with a homeless shelter was able to start a sports program to help clients engage with others. And in Oakland Park, Light of the World clinic was able to hire a full-time administrator to help speed up the process for patients to begin seeing doctors.
In a state that has not approved Medicaid expansion and where many remain without health insurance, the money was needed to help pay for key services for people who might not otherwise have them, said Mark Cruise, the executive director of the Florida Association for Free and Charitable Clinics, representing 99 clinics across the state.
“The need for free and charitable clinics is not going away, and we need a strong safety net,” Cruise said.
At Light of the World clinic, patients stream through its doors five days a week for everything from infections to diabetes. Dora Ventura, 42, has been coming to the clinic for two months. After fainting and ending up at the hospital several times because of heart and kidney problems, doctors at Holy Cross Hospital referred her to Light of the World, where she could obtain regular care.
“Before, I went to a different clinic but it was more expensive.” she said in Spanish. “But when I couldn’t pay, I canceled the appointment.” Ventura, who arrived in South Florida 12 years ago from Guatemala, said her health had deteriorated as a result.
That’s the sort of situation, Lozano-Barry said, that illustrates why free clinics like hers are so necessary. When people have regular treatments and take care of conditions early, it helps keep them out of the emergency room.
The clinic has 17 different types of specialty doctors on its roster, everything from dermatologists to cardiologists. The doctors are volunteers, as they are at all the association’s clinics. While this means the clinic can run on a budget of $500,000, minimal for a healthcare facility, last year’s influx of $45,000 from the state allocation still was a huge boon, Lozano-Barry said.
The clinic was able to switch over to electronic medical records and hire an administrator to evaluate the eligibility of patients on a full-time basis. With someone to evaluate a person’s paperwork on the spot, patients went from waiting a week or two for an appointment to a couple of days.
“That was unheard of before,” Lozano-Barry said.
But when Scott’s veto came down, Lozano-Barry had to cut the position. She’s been coming in on weekends to do eligibility paperwork on her own to prevent the time it takes patients to see doctors from spiking back up. The clinic has also applied for new grants, hoping to fill the funding gap to hire back an administrator at least part time.
Other clinic directors, like Nilda Soto, medical director and CEO of the Open Door Health Center in Homestead, said the budget pinch would mean that they would have to screen clients more strictly and possibly serve fewer people. And that raised new concerns.
“Part of health care is getting the trust of the community,” she said. “When you have to say no to somebody, that brings a lot of problems in the community.”
The grant had allowed her to update computer systems and bring on a consultant to make better presentations to donors that could in turn help secure more funds. Now, Soto said, efforts to find new sources of funding are cutting into time she can spend working with patients.
“I’m a doctor. I didn’t go to business school,” Soto said. “I have to spend a lot of time writing grants and reports instead of taking care of my patients.”
Meanwhile, even with the Affordable Care Act expanding the number of people with insurance, the number of patients coming through the Homestead clinic’s doors is only increasing, she said. Not everyone can afford the co-pays or the deductibles that usually come with insurance, so they choose free clinics instead.
A $50,000 grant was also allocated to the Miami Rescue Mission Clinic, which runs on an annual budget of $380,000 and serves the men who live in Rescue Mission’s shelter in downtown Miami. That group, too, switched over to electronic health records in the past year, bought new medical equipment and launched a sports program that helps men become more active when they’ve been out of work and live on the streets.
Jesus Inguanzo, the clinic director, said he was hoping this year’s funds could have helped expand mental health services, which are desperately needed for its clients, many who have suffered traumas. He said he felt disbelief when he heard about the veto because he considered it a “no-brainer” after Medicaid wasn’t expanded in Florida.
“It will hurt us, but we’re not going to stop our services because we didn’t get the money,” he said.
At Light of the World, Lozano-Barry said that despite her extra efforts, the time to evaluate patient’s eligibility had gone back up to where it was before the grant, lengthening the time it took for patients to see a doctor.
But for now, clinic directors said there was nothing left to do but keep trying to fill the gap in funding through new grants and outreach efforts, stretch their funds and hope for a better outcome from the Legislature next year.
“These families need to go somewhere,” Lozano-Barry said. “Gov. Scott has got to see the light on that.”