She’s never held down a job because of her learning disability. “I’m not able to work,” she said, “because the fact is my disability, I have got a learning disability and memory relapse and I can’t remember too far back, and it takes me, gosh, forever to learn to do anything, so I’m really slow on anything, so I can’t really keep a job.”
Linda’s teachers told her she had the “learning level” of a third grader. “Ever since I was little,” she says, “I was going to special education classes.” She didn’t finish high school.
Linda used to have Medicaid, when her daughter was living with her, but lost it when they both became homeless. Her daughter was 14 at the time, and went to live with a friend. Linda went out on the streets, and her Medicaid stopped. She’s reapplied three times, and doesn’t understand why they keep telling her she’s ineligible.
“That don’t even make no sense,” she says, “I’m 57 years old and still can’t get Medicaid. I can’t get nothing done. Can’t get my ears checked on, can’t get my eyes checked on, or teeth or nothing because they won’t give me my Medicaid. I got Pyorrhea in my mouth, it’s breaking every one of my teeth. My teeth are rotting out and breaking, and I can’t get them fixed because the fact is that I can’t get Medicaid.”
I have to admit, when I made the decision to write about Linda, I didn’t know squat about Medicaid. I left the interview thinking, “What the hell? Why can’t this woman get Medicaid?”
If I didn’t know squat about Medicaid, I didn’t know diddly squat about the health care system at large. As I came to find out, very few other people know much about it, either, because the health care system is fucked up. I had to do some research.
Linda says she applied three times for Supplemental Security Income (SSI), “a Federal income supplement program funded by general tax revenues,” to help people who are blind, elderly or disabled, but was turned down.
According to Section II, page 10 of the Florida Medicaid Summary of Services handbook, if you’re eligible for SSI, you’re automatically eligible for Medicaid: “All Supplemental Security Insurance (SSI) beneficiaries residing in Florida are automatically entitled to Florida Medicaid with full benefits. To be eligible for SSI, an individual must be age 65 or older (or if 64 years of age or younger, be totally and permanently disabled) and meet SSI income and asset limits.”
We can pretty much assume that she meets the income and asset limits, right? Who knows if she’s considered totally and permanently disabled. Oh, wait…
The SSI eligibility FAQ webpage says that an adult is considered disabled if, “he or she has a medically determinable physical or mental impairment which…results in the inability to do any substantial gainful activity; and can be expected to result in death; or has lasted or can be expected to last for a continuous period of not less than 12 months.”
Call me crazy, but I have a sneaking suspicion that Linda’s problem revolves around two little words: physical, and mental.
She took her case to Gulfcoast Legal Services, a non-profit corporation providing free legal aid to people like her. Gulfcoast is so backed up, they told her, she’d have to wait 18 months just to go to court. Until then, she sleeps on the sidewalk.
One administrator at Family Resources, a non-profit social service organization for children and families, says that’s not unusual. “Especially with disability (SSI), it’s gotten more difficult to get it because, I mean, you’re almost routinely turned down the first time and then you have to appeal and appeal. There’s a big backlog of cases, at least a year. If you eventually get it, they’ll back pay to when you first applied.”
Bobby and Linda told me they had gone to the Health Department to see a doctor, and were told that they couldn’t get a primary care physician because they didn’t have an address. This smacked of fish for a couple of reasons. First of all, the term “primary care physician” is often reserved for the insurance sector. These people don’t have insurance. That is their problem. So, of course they can’t have a primary care physician, right?
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But that’s not the strange part. The strange part is that they told me it was due to their lack of residence: “They won’t give me a primary care [physician] cause I ain’t got an address,” Bobby says, “That’s what they told me and her at the health department—if we didn’t have an address, they couldn’t do nothing for us.”
Maggie Hall, Public Information Director for the Pinellas County Health Department, explains. “They may have come into our St. Petersburg center without a referral and may have misunderstood what they were told about needing a permanent address. Homeless people are seen by the Mobile Medical Units that are part of Pinellas County’s outreach to homeless or uninsured people and are then referred to one of our centers by the units.”
The Mobile Medical Unit is a rolling, non-emergency doctor’s office making rounds in Pinellas and stopping in St. Petersburg on average 2-3 times a week. The unit provides treatment for brief illnesses; long-term illnesses such as high blood pressure and diabetes; lab services; school, employment, and sports physicals; pregnancy tests; referrals for some specialist care; and some prescription assistance, “to uninsured homeless residents.” Up-to-date schedules and locations are posted on the Pinellas County Health and Human Services webpage.
I asked Bobby and Linda if they'd ever visited the Mobile Medical Unit. They said yes, but most of the time, it was too far to walk. Bobby has a prosthetic knee, hip and shoulder, and Linda has those problems with her feet, they said. Linda also noted that sometimes you have to be a resident of the center where the unit stops.
There are actually two schedules for the Mobile Medical Unit because of a recent expansion grant. If you receive services on one of the schedules, you have to commit to that schedule, and cannot receive services on the other. I know that’s confusing, but bear with me. We’ll call them Schedule A and Schedule B.
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Last month, the Unit took St. Petersburg walk-ins for its Schedule A rounds at the Solid Rock Christian Recovery Center at 42nd Avenue North and 28th Street; the St. Vincent de Paul Soup Kitchen at 4th Avenue North and 15th Street; The Beacon House at Central Avenue and 21th Street; and the Salvation Army One Stop at 14th Avenue North and 4th Street.
In St. Petersburg, Schedule B took walk-ins at King of Peace (Metropolitan Ministries) at 5th Avenue North and 31st Street and ASAP Homeless Services at 11th Avenue South and 4th Street.
Bobby and Linda were excited to hear that the units' schedules are listed online. They’re going to check it out tomorrow. Hall explains that homeless citizens have to go through the Mobile Medical Units. “Because of the volume of clients we see here, especially these days, we cannot process homeless clients without a referral...Homeless people who receive help from agencies such as St. Vincent de Paul’s soup kitchens or any other group that assists the homeless receive ID cards that allow them to get meals or lodging…[T]hey can use their ID cards to get care here,” and they don’t even need a permanent address. She says it's important that our homeless citizens have ID cards because they help doctors to provide continuous care to their patients.
Bobby says the Health Department told him he and Linda could do something he called “Home Medical," but that he couldn’t do that because he didn’t have a home: “What am I gonna do? Call them up and tell them to meet me at the corner?” he says, laughing.
The program he’s unknowingly referring to is actually called Medical Home. Launched in October of 2008 as part of the Pinellas County Health Plan (PCHP), it’s a program aimed at providing free medical services to those who are living below the poverty line and are not eligible for other public assistance programs like Medicare or Medicaid. People receiving Medical Home services are assigned a “primary care physician” and can visit their “medical home” (in their case, the Health Department on Dr. MLK), whenever they want for free. Basically, this means that Linda can stop accumulating unpaid medical bills by visiting the emergency room.
“Oh, I thought it was home — like they came to your house,” Bobby said. Nope. They will need referrals from the Mobile Unit, though, and an address where they can receive mail. The Health Department receptionist I talked to this morning recommended Daystar Life Center at 226 6th Street South. Most of her homeless clients have their mail sent there.
But Linda has other options, as well.
If she can’t make it to any of the Mobile Medical Unit locations, she can check out Pinellas Project Homeless Connect on January 30th at the Coliseum, located at 4th Avenue North and 5th Street, from 8:30 a.m. – 3:30 p.m., where she’ll find over 700 volunteers waiting to guide her through a series of free medical tests and treatments, among other services — sort of a one-stop-shop for homeless needs organized by a legion of government offices, non-profit and private organizations concerned with helping the homeless in any way possible on and off the streets. PPHC will provide for a variety of needs, “including medical, dental, benefits, legal, free eyeglasses, Florida ID’s, food, bike repair, haircuts and more.” Sounds great, right? To volunteer for all or half a day, visit the Pinellas Project Homeless Connect webpage.
Bobby and Linda didn’t know about Pinellas Project Homeless Connect, but they’ll be there, along with an anticipated 1,200 other people.
Linda might also want to try visiting the St. Petersburg Free Clinic for help with her arthritis or other minor medical conditions, such as her sore feet. The Free Clinic Health Center functions in collaboration with other Free Clinic organizations, such as Beacon House and We Help Services. The Free Clinic, like the other three programs, is located right in the hub of downtown, around the corner from Linda and Bobby’s Medical Home, at 383 8th Street North. She can either call in advance to schedule an appointment, or pay a $5 administrative fee for a walk-in appointment.
And finally, if none of those options are feasible, Linda can just call 211 any time of the day or night, 7 days a week, to ask an operator what kinds of services are available in her area. I called 211 just 20 minutes ago to ask a friendly operator which cold shelters I might stay in tonight, being that temperatures are supposed to be in the mid-40s. Within five minutes, a young man was directing me to Turning Point or the Salvation Army One-Stop. Bobby said they’d heard of 211, but haven’t called, yet.
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If, for some reason, Linda can’t make it to a telephone, she can visit the Department of Health and Human Services office at 647 1st Avenue North. I visited the office this morning, and took away two New Client Packets for Bobby and Linda, as well as a complete list of social service providers in Pinellas County — complete with addresses and phone numbers — squeezed pragmatically (and somehow also legibly) onto a single sheet of paper.
