More Than a Medicaid Application

To the left of the Health Center 3 reception desk begins a narrow hallway lined with the facility’s core non-physician services: benefits counseling, dentistry, family planning, and so on. At the very front of that hallway, a pair of offices accommodates the clinic’s two newest additions.

I occupy the room marked “Insurance Specialist,” a position created last year to facilitate enrollment on the Affordable Care Act’s marketplace and alleviate some of the Medicaid application burden from the existing benefits counselors. Directly across the hall, a supervising attorney, Cynthia, operates the Medical Legal Community Partnership, launched at Health Center 3 in 2013 to meet patients’ health-related legal needs. When both our doors are propped open, I can lean back in my chair to chat with Cynthia or her assistant, Caitlin.

I was doing just that one afternoon back in October when a nurse poked his head around my door, eyes wide.

“Can you see someone?” he asked.

In came a slender, greying, Vietnamese man. I closed the door behind him as he sat down. He informed me that he had just been diagnosed with advanced liver cancer and had no insurance to pay for treatment. We immediately opened an online application for Medical Assistance. As we worked through the application, I learned more about the patient’s story. A soldier in the South Vietnamese Army, he was picked up by American troops during the Fall of Saigon and brought to the States as a refugee. He made a living as a machinist, and was now navigating the final stages of his life alone, planning not to divulge his terminal prognosis to his son in fear of yanking him away from a good-paying job in New Orleans.

As we finished the insurance application, the patient admitted that he might need some help making end-of-life arrangements. So I opened the door, took two steps across the hall, and introduced him to Cynthia. She was able to expedite an application for disability benefits and help transfer his bank account to his children — just a sample of the many services she provides through an innovative collaboration between Philadelphia Legal Assistance and the City’s public health system. As the patient got up to leave, she gently encouraged him to contact his son, who, Cynthia assured the patient, would come to his side in a heartbeat.   

A few days later, I called the patient to inform him of his Medicaid approval, and he returned to my office to select a managed-care plan. He was cheerful this time, asking about my family back home and thanking me for my help. Then he said goodbye and off he went.

But he kept coming back. During the next month he would stop in several times to say hello to me and Cynthia, always smiling and remarkably upbeat. At first he vowed to walk three miles a day to stay in shape. Once, he dropped by to announce that he had just completed his first round of chemotherapy — and still found the energy to hop on the treadmill. Just before the holidays, he brought me and Cynthia a box of chocolates. As time passed, we watched him lose hair and grow frail. He could no longer walk his three miles. I assumed each visit would be his last, but I was surprised time and again when his smiling face appeared in the corridor.

Then, one day, an even bigger surprise: he appeared again, this time joined by someone else.

“This is my son,” he said, beaming.

Heeding Cynthia’s advice, the patient had found the courage to share the news of his prognosis. His son, eager to reunite, had jumped on the first flight from New Orleans. And now there he was. He thanked both me and Cynthia for helping his dad, and then we parted ways. That was in mid-January, and I haven’t seen either of them since. Maybe the patient will surprise me again one of these days. But it’s more likely he won’t. In which case, my enduring image of him will be not the dying patient, but the proud father, standing in the front hallway of Health Center 3, grinning, arm around son.

This blog post was written by NHC Philadelphia member Andrew Romaine.
Andrew serves as an Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services Health Center 3.