Grady might limit access to free care

A Grady Memorial Hospital proposal to increase medical costs to some uninsured patients has alarmed advocates who say people will avoid care, become sicker and perhaps even die.

Grady officials on Wednesday stressed that the proposal is still in the discussion phase, but acknowledged it could cut off some people from free care.

Some of those people receiving free care have been abusing the system, and others have the finances to pay at least part of their bill, said Grady CEO Michael Young.

“We want to make sure that people who can afford to pay something will pay something,” Young said. “If they don’t have the means, they don’t have to pay.”

The plan is expected to be discussed Monday by the Grady board of directors, though officials said no final vote is expected.

Grady has already started screening people’s finances more carefully to spot those abusing the system, he said. Grady sent notices to 1,400 people this month telling them that they no longer qualify for the discount they had been receiving.

One person receiving discounted care was found to have a $750,000 house, he said. Some students have been receiving free care by only submitting their county address, when they should be the responsibility of their parents, he said. Other people hide the fact that they have insurance.

Young said he believes there are probably thousands of people abusing the Grady system by qualifying for free or discounted care they don’t deserve.

The most controversial proposal centers on prospective changes in the eligibility to receive a special “Grady card,” which allows people discounted, or even free, medical care.

Currently, Grady provides discounts for 250,000 people. Many of these people live in Fulton and DeKalb counties, which give Grady a combined total of up to $100 million a year to subsidize health care.

The plan has ignited the first major clash between the new leadership of the financially struggling hospital and the group of patient advocates called the Grady Coalition.

Coalition leaders say Grady officials are betraying the vow they made when they took control of the hospital earlier this year — to preserve Grady’s mission as a safety net hospital for the poor and needy.

State Sen. Vincent Fort (D-Atlanta), a leader of the Grady Coalition, said the proposed changes would hurt uninsured working-class people already struggling to make ends meet. He said the changes will dissuade many from seeking care at Grady.

“If I know there’s going to be a big bill hanging over me, I may not go,” he said. “People will die for lack of care.”

But Young said the hospital will not deny care to low-income people in need. Young said he understands the sensitivity on this issue, and that he does not want to discourage anyone from obtaining health care. But he said he must try to find ways to bring in more revenue for the hospital.

“We’re having a dialogue” with patient advocates and community leaders, he said.

Right now, Fulton and DeKalb county patients who earn less than 250 percent of the federal poverty guidelines — or $26,000 for one person annually — can receive free medical care. Patients outside those counties in similar financial condition pay 30 percent of their bill.

The Atlanta Journal-Constitution obtained documents from Grady on the new proposal through the state open records law.

Under the plan, Fulton and DeKalb patients who earn between 126 percent and 200 percent of the federal poverty guidelines would have to pay as much as 40 percent of their bill.

Patients from other counties, with similar finances, could pay up to 70 percent of their bill.

In addition, Fulton and DeKalb residents earning 125 percent or less of the poverty guidelines — or $13,000 for one person annually — would continue to receive free care. Those in other counties would receive up to a 50 percent discount.

For high-cost procedures, the plan would provide limits on the amount a person could be charged, depending on their finances.

Grady Coalition members say they have long worried that the new hospital administration would limit care for needy people. While this plan does not contain service cuts, advocates say it would effectively shut some people out of receiving care.

Grady serves many poor people in the Atlanta area. Through the years, patient advocates have been particularly sensitive to prospective cuts and changes to services, sometimes holding protests against proposals.