By Avram Goldstein
Washington Post Staff Writer
Sunday, June 24, 2001; Page A9

Last week, the privately run D.C. HealthCare Alliance signed up its first 100 patients, and enrollment invitations are going out this week to 44,000 others who have used D.C. General facilities in the past two years.

The program is designed to cover many of the city's 65,000 residents who lack health insurance.

The alliance rules will be similar to those of a health maintenance organization.

Primary-care physicians will provide patients with "medical homes" where they will have doctors who can give them the same kind of ongoing care that insured patients get.

The goal, officials say, is to get uninsured people to stop crowding into hospital emergency rooms for nonemergency care and to encourage private doctors to discover and manage chronic illnesses before they turn into expensive medical crises.

Here are answers to common questions about the program:

Q: Who is eligible?

A: There are three simple requirements for membership. Applicants must live in the District, have no other health coverage and meet income guidelines. A single person would qualify with an annual income below $17,180. For a family of two, the limit is $23,220; for three, $29,260; for four, $35,300; for five, $41,340; for six, $47,380.

What happens if a person doesn't qualify under those guidelines?

Uninsured residents whose income exceeds the guidelines can obtain care for fees on a sliding scale based on income, officials say. Officials expect that system to work well except when patients need non-emergency surgery, which even at reduced fees could be too expensive for them to afford.

Such patients have always been turned away when seeking non-emergency surgery at private District hospitals. They were able to have non-emergency surgery at D.C. General, but city officials say the hospital failed to keep records of how often that happened.

What if an uninsured resident who is not an alliance member wants treatment but can't prove eligibility?

The patient will automatically be covered for 30 days while qualifications are checked.

Will the alliance report undocumented immigrants to the federal government?

No. Immigration and citizenship status are irrelevant and will not be reported to other government agencies.How many physicians and clinics are there to choose from?

The roster is growing. On Friday, the alliance said it had 89 primary-care doctors and 168 specialists at 75 locations in the District. Key members are Unity Health Care, which runs charity clinics across the city, and D.C. Chartered Health Plan, a Medicaid HMO that will handle all the paperwork for the alliance.

Who are the alliance providers?

The network is headed by Greater Southeast Community Hospital, a general hospital at 1310 Southern Ave. SE. Alliance members who need hospitalization will be sent there, although officials say other uninsured residents who are not alliance members will continue to be admitted to other private institutions in the same haphazard way they always have.

Children's Hospital will provide pediatric inpatient care for alliance members, and George Washington University Hospital will admit eligible adults who need trauma or specialized care.

What if I need to go to the hospital? Where do I go?

In an emergency, any hospital emergency room is required by law to treat you and stabilize your condition. In non-emergencies, members should contact their designated primary-care physician or go to an alliance hospital.

If I just need to see a doctor, what do I do?

Call your alliance primary-care physician for treatment or a referral to a specialist. If you don't have a regular doctor, enroll in the network and go to one of its providers.

How do I sign up?

Visit one of the enrollment sites, which are open from 8 a.m. to 5 p.m. Monday through Friday. The sites are at D.C. General, 1900 Massachusetts Ave. SE, Greater Southeast and the following community clinics: Anacostia, 1328 W St. SE; Congress Heights, 3720 Martin Luther King Jr. Ave. SE; Hunt Place, 4130 Hunt Pl. NE; Southwest, 850 Delaware Ave. SW; Walker Jones, 1100 First St. NW; and Woodridge, 2146 24th Pl. NE.

For more information, call the alliance at 202-842-2810 or toll-free at 866-842-2810.

What is the emergency room at D.C. General for?

The emergency room will operate round-the-clock, but ambulances will no longer bring in patients who need surgery or hospitalization. Patients who make their own way to the hospital will be treated, but if they need inpatient care, a city ambulance will transport them to the nearest appropriate facility. Anyone who calls an ambulance will be transported to the appropriate hospital.

Victims of violence or vehicle accidents are now transported to the city's other trauma centers. Greater Southeast plans to launch its own trauma center.

Some uninsured residents see doctors at private clinics or hospitals. Should they switch?

No. The program requires all private hospitals and primary-care clinics in the District to provide the same amount of free care they delivered before. This requirement is designed to avoid a massive shift and any break in doctor-patient relationships. The clinics will not be paid by the alliance for providing the primary care.

One of the biggest problems for nonprofit primary-care clinics was getting patients to specialists for free care. The alliance agreed to provide specialty care while continuing primary care with the existing physician.

Who are the biggest losers in this change?

The estimated 5,000 Maryland residents who received free medical care from District facilities although they were not entitled to it. The alliance will screen them out, which could drive many to seek care from Prince George's County agencies.

http://www.washingtonpost.com/wp-dyn/articles/A37393-2001Jun23.html