Linda Mariano is 57 years old and 95 percent deaf. She can see without glasses, she says, but she can't read without them. Pyorrhea has rotted away most of her teeth. She has a hole in her skull the size of a silver dollar, where she was hit in the head with a brick at the age of 17 ("or 18").
I talked to Linda for over an hour the other night, sitting on the sidewalk outside the Open Air Post Office in St. Petersburg, where she's been homeless for almost seven years with her boyfriend, Bobby "Mad Dog" Donahue. As we were talking, she took her shoes off and set them next to us. I looked down at her feet. Her toes are swollen and bent, so wearing shoes is difficult. The arthritis in her knees makes it painful to walk around much, and sleeping on the concrete doesn't help.
She's never held down a job because of her learning disability. "I'm not able to work," she said, "because the fact is, 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 wound up 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. 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 left the interview thinking, "What the hell? Why can't this woman get Medicaid?"
So I decided to find out. In fact, many healthcare options are available to her, including Medicaid. But in order to take advantage of them, she has to navigate government lingo and public health bureaucracies — and that's not an easy task, especially for someone with the learning ability of a third grader.
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."
She has taken her case to Gulfcoast Legal Services, a non-profit corporation providing free legal aid to people like her. But 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 Pinellas County 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. "That's what they told me and her," says Bobby. "If we didn't have an address, they couldn't do nothing for us."
Maggie Hall, public information director for the 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. "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…" says Hall. "[T]hey can use their ID cards to get care," and they don't need a permanent address. The units provide treatment for, among other things, high blood pressure and diabetes, and provide lab services, physicals and pregnancy tests. Up-to-date schedules and locations are posted at pinellascounty.org/humanservices.
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. They were happy to hear that the units' schedules are listed online, though, and promised to check them out.
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 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 visiting the emergency room (and accumulating unpaid medical bills).
"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 spoke with recommended Daystar Life Center at 226 Sixth 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 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, "including medical, dental, benefits, legal, free eyeglasses, Florida ID's, food, bike repair, haircuts and more."
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 is located right in the hub of downtown at 383 Eighth 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 is 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 during last week's cold spell to ask a friendly operator which shelters I might stay in, being that temperatures were 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 hadn't called, yet.
If Linda can't make it to a telephone, she can visit the Department of Health and Human Services office at 647 First Avenue North. I visited the office last week 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.
I was able to help two people. But there are plenty of other homeless persons who, because they don't know what's available, turn to emergency rooms or avoid seeking healthcare at all — and neither of these alternatives is good for their health or anyone else's.
Volunteers are needed. If you're interested, contact Pinellas Project Homeless Connect at pinellasconnect.org or call 727-528-5763.
This article appears in Jan 6-12, 2010.