Puerto Rican influx worries health leaders
Dr. Amaryllis Sanchez’s last patient Nov. 10 was an elderly man who had lost everything back home in Puerto Rico, now living alone here in a hotel room and in need of medical care.
“I know I’m going to cry in the car all the way home,” said the teary-eyed Sanchez, who grew up on the island and has been a longtime volunteer primary care physician at Grace Medical Home, a free and charitable clinic in Orlando.
The clinic’s patients are typically low-income and uninsured Orange County residents, but for the past two weeks, the staff has been dedicating Friday mornings to the care of displaced Puerto Rican patients who suddenly find themselves without jobs and health insurance here.
That has local leaders worried that in the long run, this wave of uninsured individuals will overextend Central Florida’s alreadystretched safety net system.
“I’m concerned about an epidemic from the standpoint of residents who are really sick and are now being forced to evacuate,” said Marni Stahlman, CEO of Shepherd’s Hope, another free clinic in Central Florida. “We’re not prepared. Our system is fragile in Florida and here in Central Florida, and I’m concerned about caring for people who have catastrophic diagnoses.”
Across Central Florida, health providers — from small practices and urgent care centers like Night Lite Pediatrics to Planned Parenthood, safety net clinics and hospitals — are pitching in to care for evacuees from Puerto Rico.
Insurance counselors, marketplace navigators and Medicare volunteers at various locations in Central Florida have been busy helping the new arrivals find some form of insurance coverage.
And under emergency orders, Florida officials and the federal government have provided some relief and exemptions to help people switch plans and gain Medicare and Medicaid coverage quickly. But for people who are planning to stay, that’s a shortterm fix.
More than 250 displaced Puerto Ricans have visited Orlando Health emergency rooms in the past month, said Bridget Walters, who oversees enrollment and financial counselors at the health system.
And if the patient trends at Shepherd’s Hope are any indication, this could be just the tip of the iceberg.
The free clinic began its outreach at the airport in early October and has cared for at least 200 displaced individuals and families in the past month at its five locations in Central Florida. But the cases are getting more complex as people leave the island because their serious medical condition can’t be treated on the island because of lack of resources.
“At first people needed prescription medication or had needed some mild management of chronic diseases,” Stahlman said. “But we’ve started seeing more patients with drastic acute conditions related to cancer,” she said. That includes patients who were diagnosed with cancer before they had to evacuate or patients who got the surgery part of their cancer treatment and not the chemotherapy.
And for those who have made it here and don’t have immediate medical needs, health insurance is not a top priority — until an emergency arises.
“They have to adapt to a new way of life. They’ve gone through so much, and even with all the resources at the airport, they’re in shock. All of them have left someone behind. Health care is last thing on their mind,” said Vilma Quintana, a community educator and liaison for Florida Blue insurance provider.
It’s been nearly two months since Hurricane Maria made landfall in Puerto Rico and many areas are still without food and water. Last week, a major blackout once again darkened the island.
“My mom still has no electricity,” said Quintana. “Many people who were not thinking about coming are starting to think about it now because they don’t know how quickly it’s going to get better there.”
Between Oct. 3 and Nov. 9, more than 143,000 people had arrived in Florida, according to the latest state figures.
It’s not the first time that a state has become a destination for other Americans who have been displaced by a natural disaster, but the case for Puerto Rico is different.
“It’s a very unique situation,” said Stephanie Garris, CEO of Grace.
Even though Puerto Ricans are Americans, their health insurance coverage is starkly different from the mainland. Most have to sign up for new plans when they arrive here.
“We haven’t seen any insurances from Puerto Rico that we’re able to take because we don’t have contracts with the [insurance companies],” said Donna Parker, the managed care administrator of Osceola Community Health Services, a federally-qualified health center in Osceola County.
Of the island’s 3.5 million residents, about 36 percent have commercial insurance, according to a Jan. 2017 report by the nonprofit think tank Urban Institute. Less than a quarter is covered by Medicare, a majority of whom have Medicare Advantage, and about 40 percent are covered by Puerto Rico’s Medicaid.
“My big concern is that so many people are coming with Medicaid who don’t qualify here,” said Sanchez. “A lot of them end up in the ER with simple problems.”
Medicaid eligibility requirements in Puerto Rico are more liberal than the states, including Florida. That means some displaced individuals won’t qualify for Medicaid in Florida, while they can’t afford to pay for private health insurance. Some earn too little to qualify for the subsidized health plans on the exchange.
Sanchez’s patient Nov. 10 fell in Medicaid gap on the island and most likely here, too.
After she finished the exam, she stepped out and asked Marcelo Baradona, a local pastor who was volunteering at Grace that morning, to go in and pray with the patient.
“It’s truly a disaster,” she said. “Some people have lost everything and for many, families are being fractured.”
“I’m concerned about an epidemic from the standpoint of residents who are really sick and are now being forced to evacuate.” Marni Stahlman, CEO of free clinic Shepherd’s Hope