Partnership between law firm, free clinics is helping those cut off from health care coverage

Less than two months before a $60,000 surgery, Graciela received notice that her state health care insurance was ending. She would have to pay out of pocket.

But thanks to the advocacy of a nonprofit public interest law firm called ABC For Health, her coverage was restored. The surgery happened in January at no cost to her.

“The ABC team identified procedural and legal errors that led her coverage to incorrectly terminate in December of 2023 instead of the proper date of March 2024,” the firm reported.

Graciela is a pseudonym used by ABC For Health to protect the patient’s privacy. The firm says she obtained free legal services to restore her BadgerCare Plus coverage through a new partnership between ABC For Health and 10 free clinics around the state, which has resulted in more than 800 people receiving health care benefits.

Graciela and more than half of those receiving support under the new partnership for BadgerCare Plus, emergency Medicaid or financial assistance identify as Hispanic. Their primary language is Spanish.

“We were surprised at how high a level the Spanish speaking referrals were,” said Brynne McBride, ABC for Health’s chief operating officer and public interest attorney.

Of the roughly 70,000 patients served by the Madison-based organization over the past three decades, about 20 percent annually are Spanish speaking, McBride said.

“We call ourselves a health equity and social justice law firm, and we were serving exclusively low-income families across Wisconsin,” McBride said. “But we weren’t catching all of these folks. The free clinic folks exposed us to a population that was being missed before at a much higher level.”

In Graciela’s case, ABC For Health says her coverage ended mistakenly as states began to review Medicaid eligibility in the wake of a pandemic-era mandate expiring in March 2023. The process is known as “unwinding.”

According to KKF Health News, 64 percent of people disenrolled in Wisconsin during the unwinding process had their coverage terminated for procedural reasons. The state Department of Health Services estimates more than 300,000 Wisconsinites currently lack health care coverage. 

Not all Spanish speaking patients referred to ABC For Health are affected by the unwinding process, according to McBride. Others faced financial assistance applications from hospitals that required a higher burden of proof for Spanish speakers. And some just simply needed a translator. 

If people call help service lines through county agencies that partner with the state and phones are answered in English, patients often drop those calls, McBride said.

“When that happens, the client drops, the patient drops and they’re gone. They’re not coming back, because they’ve already hit a barrier,” she said.

Referral and screening tool

A screening and referral tool, known as FirstCheck Wisconsin, allows staff at free clinics to identify patients who are likely eligible for health care coverage and remain uninsured. Those patients are referred to ABC For Health, where they can get guidance and legal services.

Open Arms Free Clinic in Walworth County is one of the 10 participating clinics around the state. The clinic is staffed with volunteers and provides free services to people in the county. About 12 percent of county residents identify as Hispanic or Latino, which is higher than the state average of nearly 8 percent, according to the 2020 census.

“Our Spanish-speaking patients will do all the right things. They’ll call the financial advocacy program and try and apply. But because there is this language barrier, it gets confusing, and then they could possibly be denied wrongfully because we’re losing some stuff in translation,” said Jaime Wiley, the clinic’s manager.

The clinic serves workers in tourism, agriculture and manufacturing industries where most employers don’t provide health insurance, according to its website. Wiley said most health care providers are focused on serving patients’ immediate health care needs rather than assisting eligible people gain access to health insurance.

“We don’t have the capacity to sit down with every patient that needs help,” Wiley said. “We can connect them with the care, but ABC For Health has been able to provide the legal advocacy.”

An estimated 28 percent of uninsured residents are eligible for BadgerCare, according to a 2022 market analysis for state authorities who regulate insurance providers.

The screening and referral tool used by free clinics started with clinic staff submitting handwritten notes to ABC For Health via fax, McBride said. Now the tool is digitized and the organization hopes to soon create automatic referrals. 

ABC For Health hopes to expand the referral and screening tool to other free clinics in the future, to ensure more people have access to legally eligible health care benefits.

“It takes all of us,” McBride said. “People living and working in Wisconsin deserve to be healthy.”

Eliminating medical debt

The partnership between free clinics and ABC For Health has also eliminated nearly $600,000 in medical debt for families, according to the firm.

One Whitewater family interviewed by WPR described having more than $60,000 in medical bills erased. The bills stemmed from care for brain arteriovenous malformation, which left a woman unable to walk without assistance and dysfunction in the left side of her body.

“It was hard enough coming to terms with my diagnosis, and then you’ll be getting bills and phone calls. It was quite distressing,” the woman said.

After Open Arms Free Clinic referred her to ABC For Health, she got on BadgerCare Plus and was able to retroactively receive coverage, eliminating her medical debt.

“Now we are the happiest poor people in the world,” she said.