Local organization reduces burden of health care

The Rain offices in Columbia, July 15, 2015. Rain was founded in the early 90s as a faith based organization to provide care for people dying of AIDS. The organization now provides housing assistance and case management services for HIV patients in 62 counties in Missouri. ADAM VOGLER/Missourian

The Rain offices in Columbia, July 15, 2015. Rain was founded in the early 90s as a faith based organization to provide care for people dying of AIDS. The organization now provides housing assistance and case management services for HIV patients in 62 counties in Missouri. ADAM VOGLER/Missourian

Story written by Breyanah Graham.

COLUMBIA — Because of the financial burden caused by the expensive cost of her health care, retired teacher Samantha Jones has lost faith in the health care system.

“I pay $500 a month out of pocket for my health care that is not covered by my insurance,” Jones said. “It’s not affordable. You have other things, and if you are paying four, five hundred a month it’s so hard, especially for people that don’t have a lot.”

Jones is one of the many people in the U.S. who don’t have the health care coverage. Her insurance has coverage gaps, leaving her with high medical bills.

“You either have insurance or you don’t,” Jones said. “We have so many people that need medical help. They have insurances that they can’t afford, bills from doctors. It’s a problem everywhere.”

With the passing of the Affordable Care Act, or Obamacare, more low-income Americans are able to get affordable and quality health insurance. “The percentage of working-age adults who are uninsured has dropped from 18 percent to 13.4 percent,” according to the latest edition of The Commonwealth Fund’s Affordable Care Act Tracking Survey recorded in May. These numbers reflect that the Affordable Care Act coverage is helping many people that could not have previously afforded health care.

However, while the Affordable Care Act has made insurance affordable for many people, its benefits have not been accessible for everyone. Under law, states are allowed to decide whether to expand Medicaid to people who are not eligible for its coverage. For people such as Jones who do not qualify for Medicaid or government aid, this means that the majority of the cost of their health care has to come out of pocket, which can cause a serious financial burden.

Cale Mitchell, the executive director for Rain-Central Missouri, has seen the burden firsthand. Rain is a nonprofit aid service organization that works with low-income individuals with HIV, Hepatitis, and sexually transmitted diseases.

“Income inequality and health care inequality go hand in hand,” Mitchell said. “When they come to us, they have other needs that need to be met besides health care, like housing and education. It’s like the chicken and the egg for them. Which one comes first?”

For low-income individuals who are living with HIV/AIDs, not being able to qualify for government funding is even more troubling. The Centers for Disease Control and Prevention reports that the estimated lifetime cost of treating HIV is $379,668. With the federal minimum wage of $7.25 per hour, a full-time minimum wage employee making the federal wage only earns $15,080 annually, not even half the cost of treating HIV annually.

Fortunately for individuals who have limited access to health care, there are places like Rain that specialize in helping people at risk for, or infected with, STDs and other potentially life-threatening diseases.

With the help of funding from Ryan White Health Care, Rain has spent the last 25 years helping people with HIV/AIDS get affordable health care.

“Many more people that have HIV/AIDs are able to be insured now, but there are many people who fall through the cracks,” said Mitchell. “For those that are HIV positive, by utilizing federal dollars, we sent them to doctors and help them get proper treatment.“

For people with HIV/AIDs and other potentially-life threatening diseases, not being able to get proper health care can be detrimental to their health.

“It doesn’t help that there is so much stigma attached with the disease,” Mitchell said. “Ninety-five percent of people with HIV come to Columbia to receive health care because they are afraid that someone will find out that they are HIV-positive.”

As a result, Rain is lowering the number of uninsured HIV/AIDs individuals in the Mid-Missouri area. Rain reports that they serve just over 400 individuals in a typical year.

“Income is a barrier to a lot of things,” Mitchell said. “The amount of effort is certainly more, but it’s not impossible to help them.”

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Stress of poverty linked to psychological changes

Mary Tyler at the Central Missouri Community Action offices in Columbia Thursday, July 15, 2015. Tyler took financial classes at the center while unemployed and now works there. ADAM VOGLER/Missourian

Mary Tyler at the Central Missouri Community Action offices in Columbia Thursday, July 15, 2015. Tyler took financial classes at the center while unemployed and now works there. ADAM VOGLER/Missourian

Story written by Madeline Jarrard.

COLUMBIA — The stress of poverty — worrying about housing, wondering about the likelihood of a next meal, tabulating a meager income against mounting expenses — isn’t hard to imagine. Over time, though, that anxiety can cause subtle changes in the brain.

Poverty is linked to a reduced attention span and limited ability to multi-task, which add to the numerous obstacles faced by those who struggle financially, according to a 2013 study published in in the academic journal Science. Poverty, the researchers wrote, “captures attention, triggers intrusive thoughts, and reduces cognitive resources.”

The study indicated that the implications of poverty are more substantial than a lack of money − they relate to the functionality of one’s brain. The researchers found a correlation between the stress of poverty and poor decision-making. Cognitive capacity is the amount of information one can retain, and those living in poverty suffer from a “tunneling effect.”

Teri Roberts is the Asset Development coordinator for Central Missouri Community Action. At the center, she teaches a variety of finance education classes, including budgeting.

“Our clients are low income, so they struggle to meet basic needs,” Roberts said.

Roberts teaches students to manage the money they have and to live on a budget. There are many people who don’t know basic financial information, she explained.

But Roberts does more than teach finances. She explained that the general mindset of people who enter the class is they “can’t even pay the bills, much less save money.”

But this mindset is tangible for all people.

According to the study, financial concerns have a cognitive impact comparable with losing a full night of sleep. Researchers cited that the effect of poverty is similar to a drop in cognitive ability by 13 IQ points.

The goal is to avoid the “poor decision making” that poverty threatens.

Roberts finds simple ways to encourage better spending habits. “We all have money we fritter away,” she said. She calls it “fritter finder,” where people find things in their lives that are not necessities. She gives the examples of lottery tickets and other expenses that add up.

The change that Roberts makes is tangible. There were pre and post assessments taken of individuals who took the budgeting class. Of the 20 to 25 people analyzed, the difference before and after the class was substantial. Roberts cited an 89 percent increase in knowledge demonstrated by the tests.

Mary Taylor, 36, participated in the budgeting class when she was unemployed and low on money.

“I wasn’t doing near as good as I thought I was,” Taylor said.

Taylor, who had Roberts as a teacher, explained how helpful it was having a budget plan.

“I definitely felt more confident,” she said.

Now, Taylor works for Central Missouri Community Action at the office in Boone County.

Angela Hirsch, the Community Services Director, explained more about the goals of the classes.

The budgeting classes at Central Missouri Community Action help teach people to best utilize the money they do have. Instructors help their students create a path to their goals: buy a house, go to college, or simply live within their means.

But for some, the goals come in small steps.

The penny roundup is another way the instructors teach how to save money. Individuals are taught to save the coin change from all of their purchases. For example from a $9.50 purchase one could pay with $10 and save the 50 cents.

“That starts to add up,” Hirsch said.

Affordable addiction treatment hard to find for those without health care

Story written by Jordan Meier.

COLUMBIA — Stefie Sylvanog grew up surrounded by addiction.

Her mother was addicted to K2 and other drugs. Her stepfather was addicted to alcohol. She grew up without a lot of money.

“Addictions around here are easy to come by and hard to break,” said Sylvanog, 29, as she smoked a cigarette outside the women’s shelter where she lives.

Sitting at a picnic table outside St. Francis House, Sylvanog, who uses the name professionally for her photography business, said she is clean now except for the cigarettes, but she used to be addicted to the prescription drug Adderall.

According to the U.S. Department of Health and Human Services, one out of 10 Americans making less than $20,000 a year struggle with addiction. For many, the lack of money correlates to a lack of access to affordable treatment, which can create a barrier to overcoming addiction.

As she lights her fifth cigarette, Sylvanog tells the story of her addiction. When she was younger, doctors had her take extremely high doses of Adderall to control her ADHD. They started out giving her normal doses of the medication, but when her body stopped responding to it, the doctors just kept increasing the dosage. At one point she said she was taking 650 mg of the medication a day. According to the Food and Drug Administration, a normal dose of Adderall for children is 30 mg.

“250 mg in the morning, 150 mg in the afternoon, and 250 at night. You do the math,” she said.

When Sylvanog first tried to get off the medication, she went through major withdrawls and only lasted one week before she was forced by her father and grandparents to start taking it again, she said.

“Do I blame them? Yes. They couldn’t see that I was a child who didn’t need this s— in my system,” she said.

After moving in with her mom, Sylvanog said she continued to struggle with the addiction for years and even overdosed a few times.

“I was crying out for help and people were seeing it, but they didn’t know what to do,” she said.

Sylvanog said the only reason she was eventually able to get the treatment she needed was because she was under 18 and qualified for Medicaid. After signing up for Medicaid, Sylvanog went to a doctor and started getting off the pills. Once she was off Adderall, she went to a Boys and Girls home where she got therapy to work through some of the trauma she had experienced as a child.

“They saved my life,” Sylvanog said of her time at the Boys and Girls home.

If she were to need addiction treatment now, however, she would have a difficult time paying for it. Medicaid primarily covers adults with disabilities and low-income children and their parents in Missouri. She can’t afford private insurance.

Missouri does provide funding for treatment centers statewide, so patients without private insurance can get help. The majority of that funding historically has come from Medicaid. However, last year the Missouri Department of Mental Health added a new program called PR+, or Primary Recovery Plus.

“PR+ programs were largely modeled after the CSTAR General Population Programs but do not have some of the services available in CSTAR.  It offers a full continuum of services within multiple levels of care to assist individuals without Medicaid coverage,” said Debra Walker from the state’s department of mental health.

Comprehensive Substance Treatment and Rehabilitation (CSTAR) is the state’s Medicaid substance abuse treatment program.

Despite this, experts interviewed for this article as well as those in the state’s department of mental health agreed that treatment is still hard to come by for people without insurance.

“There are usually more individuals needing treatment than treatment providers can serve,” Walker said.

“The services are effective, there just isn’t enough of them,” said Denis McCarthy, a MU psychology professor specializing in alcohol addiction.

To Sylvanog, the solution is simple.

“Make treatment more available to those who need it and want it. That’s the key, people who want it,” she said. “Give people means to end the cycle.”

In Sylvanog’s experience, the closest thing a person without medical insurance gets to treatment is when he or she overdoses on drugs and goes to the hospital. Then the person can get clean and sober for a few days before being sent back out onto the streets.

“(The hospital) gives fare for a cab service and that’s about it. They have 4-5 days of sobriety and then they are back out on the streets doing the same s—,” Sylvanog said.

Americans who make more than $20,000 per year are less likely to be addicted to drugs or alcohol — about 7 percent of people with higher incomes are addicted to drugs compared to the 10 percent of people in the lowest income bracket, according to the U.S. Department of Health and Human Services.

But people aren’t more likely to be addicted simply because they’re poor, Walker said.

“There is a correlation between household income and substance-use disorders. This is a complex relationship and a correlation does not mean that one causes another,” said Walker, adding that transportation can also be a challenge for people who don’t live close to treatment centers.

Even though portions of people in poverty do struggle with addiction, many of them want to get help, they just don’t know how to get it, said Sylvanog.

Central Missouri Community Action is working to solve that problem in Columbia. As part of the community outreach agency’s efforts to alleviate poverty in mid-Missouri, the organization helps people find treatment for addictions if they need it.

“People (in poverty) want more,” said Angela Hirsch, the agency’s community services director. “It’s simply an issue of not knowing how to get there.”

County has options for poor deceased

Brian Gardner is a local mortician, who owns and operates Columbia Cremation Care Center. LOREN ELLIOT/Missourian

Brian Gardner is a local mortician, who owns and operates Columbia Cremation Care Center. LOREN ELLIOT/Missourian

Story by Erin Sastre.

COLUMBIA — For many people, funerals are an opportunity to celebrate the life of a loved one. But with the cost of a traditional funeral averaging between $7,000 to $10,000, some mourners may be too busy worrying about how they will pay the bill.

According to the U.S. Census Bureau, 20 percent of Boone County citizens live below poverty level. For the destitute, death brings no relief.

County officials have been setting aside money to help pay the cost of burying or cremating indigent residents since at least 1987, according to county records.

A bill in 2007 revised the policy — cremation now is the only option — and increased the budget allowance, setting the rate at $250 for adults and children to account for increased expenses. Since 2009, a total of $5,000 is budgeted for the service countywide.

The process involves both private and public agencies. When someone who may be impoverished passes away, his or her body is sent first to the medical examiner’s office or morgue. There, any known next of kin are contacted to claim the body.

“Some are here for as long as they can so family can come claim them,” said Stacey Huck of the Boone County medical examiner’s office.

If no one claims the body or no family members are found, the county works with funeral homes in the Boone County area to provide services.

“After 30 days, bodies are considered county property, and we provide a death certificate and cremation,” said Clay Vogl, manager and funeral director at Parker Funeral Service in Columbia.

The next — and often final — stop is the medical examiner’s office.

“The remains are sent back to our office if they aren’t claimed,” Huck said.

Brian Gardner is a local mortician, who owns and operates Columbia Cremation Care Center. LOREN ELLIOT/Missourian

Brian Gardner is a local mortician, who owns and operates Columbia Cremation Care Center. LOREN ELLIOT/Missourian

In rare circumstances, family members who were not aware an indigent resident’s death are able to petition the medical examiner for possession of the remains, she said. But some are never claimed.

“We have several cremated remains (in storage),” she said. “Thirty, if not more.”

When remains go unclaimed, they haven’t necessarily been forgotten, Huck said.

“It’s more likely that family is unwilling or unable financially to claim remains,” she said. “Typically, if a family doesn’t pay, if someone said, ‘We can’t take care of the cost’… the remains will stay in this office indefinitely.”

A county cremation isn’t the only option for financially unstable families, however. Other programs and businesses provide economic options for laying loved ones to rest.

MU’s Gift of Body program offers free cremation of bodies that are donated for study by students in the Department of Pathology and Anatomical Sciences. The program allows residents — including those who might lack the resources to pay for a traditional funeral — to provide for their own cremation or that of a loved one while contributing to the advancement of medical science.

Military veterans have another option. Many service members qualify for a free gravesite and a government-provided headstone at one of 131 national cemeteries or a state veterans’ cemetery in the state where the veteran lived at the time of death.

Private funeral homes also may offer discounted services to those in need or help tailor a funeral to match a limited budget.

“The service price depends on the needs and means of the families,” said Vogl. “We try to work with them as best as we can.”

Medicaid benefits aren’t enough to break the cycle of poverty

Attorney Max Lewis types on his computer using a stylus on Tuesday, July 14, 2015. Lewis became a quadriplegic almost 30 years ago after diving 21 feet off of a bridge. AMBERLE GARRETT/Missourian.

Attorney Max Lewis types on his computer Tuesday using a stylus. Lewis became a quadriplegic almost 30 years ago after diving 21 feet off of a bridge. AMBER GARRETT/Missourian.

Story by Lauren Frias.

COLUMBIA — Family lawyer Max Lewis is living with a severe spinal cord injury caused by a diving accident in 1986. He is paralyzed from the neck down with only limited use of his left arm.

As a quadriplegic, Lewis is one of many who rely on personal attendants to help him for six hours a day, every day. Attendant services are provided to him through Medicaid benefits, so Lewis doesn’t need to pay for them out of his own pocket.

“Without attendant care, I will die,” Lewis said. “Without attendant care, I don’t eat, I don’t drink, I don’t get out of bed, I don’t dress, I don’t bathe, I don’t go to the bathroom. About the only things I can do on my own is work on the computer and answer the phone. And even to do that, I have to have somebody help me get out of bed and put me in a wheelchair and put my keyboard on my lap board. Every basic function of life that I have a need for I have to have help doing it.”

At about $9.15 an hour for attendant service, Lewis estimated the average yearly cost of this necessary help to be $20,000. The cost of doctor appointments and medication are added alongside attendant expenses. And Lewis’ wheelchair to provide him mobility is valued at $25,000.

Attorney Max Lewis works on his computer at home on Tuesday, July 14, 2015. Max lives below the federal poverty level to receive assistance for his disability, caused by a diving accident in 1986. AMBERLE GARRETT/Missourian.

Attorney Max Lewis works on his computer Tuesday at home. Max lives below the federal poverty level to receive assistance for his disability, caused by a diving accident in 1986. AMBER GARRETT/Missourian.

Paying his medical expenses is no small task, Lewis said. That is why he decided to work as a lawyer, making $826 a month, to qualify for Medicaid and health insurance that covers the cost of his attendants and health care. In Missouri, Lewis said, to qualify for Medicaid, an individual must remain under 85 percent of the federal poverty level, which is $895 a month.

Advocates for the rights of the disabled said that Medicaid eligibility requirements continue to stifle individuals with disabilities from striving for economic independence, forcing them to settle for impoverished lifestyles to receive health care benefits.

Medicaid spokeswoman Marilyn Jackson responded in an email that questions about how the program may be keeping some recipients impoverished were “not simple to answer.” She did not respond to specific questions emailed to her Thursday.

Besides dealing with the federal regulations about his health, Lewis said he finds himself with a more personal challenge with living under the federal poverty level. He said he cannot marry his fiancée, Wanda Jesse, without losing all his Medicaid benefits. He has been engaged since January 2012.

If the couple were to marry, Lewis said he would have to make a tough choice. On one hand, his fiancée would have to quit her job at the Harry S Truman Veterans’ Hospital, which would force her into poverty in order for him to keep his health care benefits. Or Lewis would have to find full-time employment and lose his Medicaid coverage.

“We love each other,” Lewis said. “We would love to get married. They just came out with the law … that, whether it be same-sex marriage or not, you have that right to get married. But that right between her and I is forgone unless I chose to live without insurance or attendant care or force her into poverty.”

Familiar with Lewis’ story, Tec Chapman, executive director of Services for Independent Living, said Lewis is a prime example of the faults in the impoverished health care guidelines, saying that his situation “illustrates the flawed public policy involved with Medicaid.”

Chuck Graham, associate director of the Great Plains Americans with Disabilities Act Center, said because most insurance companies don’t cover attendant care, many individuals with disabilities rely on the benefits of Medicaid to receive needed care at an affordable cost.

Chapman said an individual living in Missouri with a disability is 2.5 times more likely to be living under 100 percent of the federal poverty level than a person without a disability.

“(Medicaid) policies continue to impoverish people (with disabilities), preventing them from becoming economically independent,” Chapman said, adding that the program’s policy “marginalize individuals” and keeps those with disabilities to live in poverty.

The Bureau of Labor Statistics conducted a study in March known as the Current Population Survey, which showed that people with disabilities ages 16 and up face an unemployment rate of 11.7 percent, and people without disabilities face 5.3 percent.

Stamps and papers cover Max Lewis' desk on Tuesday, July 14, 2015. Lewis works as a pro bono attorney in divorce and custody cases. AMBERLE GARRETT/Missourian.

Stamps and papers cover Max Lewis’ desk on Tuesday. Lewis works as a pro bono attorney in divorce and custody cases. AMBER GARRETT/Missourian.

The same study also defined a contrast between both groups’ participation in the labor force — individuals with disabilities are only 19.8 percent of the workforce, compared to people without disabilities making up 68.3 percent.

Several activists have tried to change federal public health policies to correct this dependence on poverty among individuals with disabilities. However, Graham said, they have not spurred any legislative action in the matter.

“I think it’s because most of the people who design the policy have never been on Medicaid,” Graham said. “They don’t have disabilities, so they don’t understand what it takes to be able to go to work.”

Though no steps have been taken to resolve the situation, Graham said he recognizes a simple solution. With the consent of legislative officials, he said Medicaid policies could be restructured to prevent people with disabilities from resorting to a life in poverty.

“The state has the ability to do Medicaid expansion, which can go up to (include) 130 percent of the federal poverty level, allowing somebody to make almost double than what they do now and continue to receive attendant care services,” Graham stated. “The legislature can do something with one vote and no additional money by saying yes to Medicaid expansion.”

Local food providers encourage healthy eating

Adam Vogler/Missourian. Assistant produce manager Jordan Fowler stocks grape tomatoes at Lucky's Market Wednesday, July 15, 2015.

Assistant produce manager Jordan Fowler stocks grape tomatoes Wednesday at Lucky’s Market. ADAM VOGLER/Missourian

Story by Luc Pham.

COLUMBIA — When people who are struggling financially come to the Food Bank for Central and Northeast Missouri for help, Gail Clarkson said the first step is to speak with them about their future.

She said it’s important to make sure they are making the right choices with what they have, especially when it comes to food.

“We try to talk to them, visit with them, give them suggestions (and) possibilities of doing different things with food they might be rethinking about,” said Clarkson, the former director of the Food Bank.

While those with fewer worries about their spending might have the luxury of more food choices, nutrition is not always in the forefront of everyone’s mind, said Mike DeSantis, communications coordinator of the Food Bank. People will eat what they want to eat.

And even if they want to eat healthier, regardless of income, people don’t always have the option to do so close at hand.

Assistant produce manager Jordan Fowler stocks grape tomatoes at Lucky's Market Wednesday, July 15, 2015. ADAM VOGLER/Missourian.

Assistant produce manager Jordan Fowler stocks grape tomatoes Wednesday at Lucky’s Market. ADAM VOGLER/Missourian.

A traditional grocer, Lucky’s Market, opened last year in downtown Columbia, an area that was identified in 2009 by the U.S. Department of Agriculture as a “food desert” because it offered residents little access to fresh market foods.

MU english professor Elizabeth Chang said she shops at Lucky’s not only because it’s close to her house, but also because she likes the benefits of the store’s more organic, “relatively unprocessed” products for her family.

“I have three little kids,” she said. “Lucky’s is a huge game changer.”

The franchise, based in Boulder, Colorado, has located many of its markets in college towns, and it operates with the goal of “giving back to the community” and “supporting local vendors and local suppliers,” said Jon Heisinger, the second assistant store director at Lucky’s Market in Columbia.

“Overall, we just want to provide really good food at a good price so people can eat healthy,” he said.

He concedes that homegrown organic food can be pricey, but customers can find it easily “if they’re willing to pay a little extra.”

Jordan Fowler, the assistant produce manager at Lucky’s, agreed, “It is more expensive to buy local.”

But they both said the store’s prices are competitive with other markets.

“The dollar is always key,” Fowler said. “Generally if it’s cheaper, it will sell better.”

Yet, even as markets like Lucky’s supply urban areas with food choices that some shoppers embrace as healthier, fast-food options are prevalent.

Chang said she makes a conscious decision to avoid fast-food establishments for two reasons: she doesn’t like the taste, and she doesn’t want to feed into the corporatization that they represent.

Andrea Lang, a student at Columbia College who both works at and shops at Lucky’s, said, “Fast food is definitely cheaper, but the nutritional value of making your own food outweighs it.”

The available options at the Food Bank try to influence the choices that people in need make.

”Ninety-five percent of the food we give out is “good food,’” said DeSantis. “Only five percent of the food we give out is snacks (such as) cookies and soda.”

The need is undeniable. The Food Bank delivers about 30 million pounds of food to around 114,000 clients annually.

For nine years, Patsy Bulington was one of those clients.

Bulington, 66, of La Plata, started using the services provided by the Food Bank in 2005, when her budget was stretched after she took in three of her grandchildren.

“We couldn’t get help from the government,” said Bulington. “They told us we made too much money.”

She struggled to juggle a series of low-paying, short-term jobs, along with her children, an out-of-work husband on disability and countless financial crises primarily on her own.

By providing her with meat, vegetables and pasta, she says the Food Bank helped supply her family with healthy meals while she got back on her feet.

But even for those who need the assistance, DeSantis said the food provided is intended only to “tide them over.”

“We don’t want people dependent on our services,” he said. “We want people to get out and change their own lives.”

Clarkson agreed.

“We try to behave in a good Christian manner, and also encourage people, let them know that it’s going to get better,”she said.