Victoria Veltri: In Hartford, the health safety net of the safety net

By Victoria Veltri • Hartford Courant • Jan 11, 2023

Connecticut is a healthy state by most health measures, yet a substantial number of our uninsured residents lack access to health care coverage and places to get ongoing, high quality, comprehensive health care in their neighborhood and from people they trust. We routinely refer to the “safety net” in health care. Malta House of Care, Inc., is one of a handful of free clinics in the state, a subset of nonprofit clinics in the state that carry a special designation from the federal government, as “free clinics.”

We are the safety net of the safety net.

Malta collaborates with partners in the health care delivery system, including hospitals and community health centers. Malta provides comprehensive primary care via a model that avoids the complications of billing and misaligned payment incentives that dominates the health care delivery system. We coordinate care that provides over 5,000 patient visits a year, through team-based care, and we do it with a small cadre of clinical staff and a pool of dedicated volunteer providers, including MDs, APRNs, PAs, behavioral health providers, nurses, and students in training for all roles. We also include medical interpretation, comprehensive medication management, and patient navigation.

Our patients face extreme barriers to well-being — poverty, unstable housing, unstable employment, food insecurity, high chronic disease burden, and much higher rates of disparities in access to services and health outcomes than insured residents experience. Our patients represent over 50 countries of national origin and speak over 25 languages.

Free clinics like Malta House of Care in Hartford serve residents who are ineligible for Medicaid, Medicare, or health insurance on their own or from an employer. We do not receive a regular source of funds from the state or the federal government. Malta cannot (under federal law) charge or accept payment from our patients for our services. We are free to our patients; Malta is one of a small group of clinics that comprise the safety net of the safety net.

You might be wondering; how can that be true? Doesn’t everyone have access to Medicaid or Medicare? Anyone can go the emergency room, right? Well, those are good questions with complicated answers. No, not everyone is eligible for Medicaid or Medicare. Emergency rooms are one of the most expensive sources of care, and they are not free, unless one qualifies for financial assistance or has health coverage. They are not equipped to be ongoing sources of care for people. While there are more options for health coverage than there used to be, coverage is not available to everyone.

Malta focuses our resources on comprehensive primary and preventive care – we focus on trying to promote health by providing care and addressing social, economic, legal, and other drivers of health. We provide these services at a stationary site in Hartford and at our mobile medical clinic locations in Hartford and East Hartford. We know that people with a usual source of care have better outcomes. Malta is the medical home for our patients, coordinating their care among other providers, and navigating other barriers to our patients’ well-being.

We collaborate with community health centers and providers in our area and hospitals for referrals for patients for ongoing specialty care or urgent specialty care. We complement the existing fabric of clinic sites that accept coverage and are obligated to charge uninsured patients for care. We exist to ensure access for people who cannot pay for health care. Free clinics are an absolute necessity because meaningful access to health care is a human right.

This necessity comes with its own challenges and rewards — raising funds for operations, including reliance on individual donors, philanthropy, and corporate giving for services; partnerships with local providers, industry, community organizations, and the towns where are our patients live; competition for precious dollars to keep the lights on, and a much larger need than apparent to most of us who are well-insured and well off.

Tens of thousands of uninsured patients in the Greater Hartford area need the services of Malta. Until we offer health coverage for everyone, free clinics will be here to offer access to high quality, ongoing care for our uninsured residents.

Victoria Veltri is the executive director of Malta House of Care, Inc. in Hartford, CT.


Original article can be accessed on The Courant’s website.