Baking can be a very complicated process when it involves ensuring enough portions for a big group of people, not to mention if that specific cake requires very careful, and very precise chocolate preparations. "Everybody loves chocolate, and I love to bake," says Rose Mancini, a part-time registered nurse at the New Orleans Musician's clinic. But what about when too much chocolate turns against you and your teeth in the form of cavities? As the New Orleans Musician's Clinic (NOMC) knows so well, treating the dental needs of any patient can be very expensive. "How many crowns does he need?" Mancini asked one of the employees at the New Orleans Musicians Assistance Foundation. "Four, valued at $2,000 each," the employee replied. "Oh. That's one of our many problems," Manici continues. "Always needing and then finding enough money."
Although in March 2010 Congress passed the Affordable Care Act which President Obama signed into law to reform healthcare in the United States, this still leaves more than 90 percent of New Orleans musicians without the immediate help and coverage necessary to survive now, according to NOMC President, Bethany Bultman. "We at the NOMC are doing everything we can to keep the music alive," she says. "It's crazy to think people care about the music, and not the musician. We need to keep them alive and well."
Founded in 1998, NOMC treats more than 2,000 patients, 85percent of whom are treated for chronic conditions such as, hypertension, depression and diabetes, says Bultman. The NOMC provides a full range of services that focuses on education, treatment and prevention, but musicians are faced with a lifestyle that causes serious health risks which can include hearing loss, carpal tunnel syndrome, first or second-hand smoke and lung problems, and often, psychological depression.
"It's not just about the physical, it's about their mental health as well," says Mancini, who primarily teaches free classes on diabetes treatment and wellness. "All the pressures they're under along with finances and family really takes a toll on their mental well being."
The NOMC works on the honor system based on the musician's salary which is often below the poverty line at only $12,000-$15,000 dollars a year, Bultman says. They pay what they can afford which often involves a $10 co-pay for each visit. When musicians first come into the clinic, they meet with a nurse practitioner, Catherine Lasperches, for at least an hour to try to assess all the musician's concerns. After the initial consultation, if the clinic does not offer what the musician needs, the nurse refers them to a doctor or pharmacist who charges discounted rates.
"This is the first time that many of them have had a private doctor; the first time they've had continuity," Mancini continues. Not only have the NOMC extended their coverage to all "tradition bearers" including Social Aid and Pleasure Club members, visual artists, dancers and even the bartenders and waitresses who work in music clubs around the city, but they have also even extended their services to every member of the household 18-years-old and over-- even if they are not biological family members. "We want the people in the support system to be involved," says Bultman. "We want to be a resource to keep the culture alive. It's a battle...if we don't fight, who will?"
The NOMC also started a second program after Katrina called the "Gig Spot" that pays musicians $100 during a slow gig season so that they wont be without any income. The clinic even takes care of those without proper transportation of getting to the NOMC by setting up an account with United Cab. And other team members, Medical Assistant, Louise Griffin, and Social Services Intake Coordinator, Megan McStravick, are also there to pick up on issues affecting musician health care such as unsafe living environments for the elderly and the inability to fill some prescriptions by reaching out to patients to follow-up and make sure everything is ok.
In September of 2007, the Primary Care Access and Stabilization Grant (PCASG) was awarded to Louisiana. This one-time $100 million dollar grant program was designed to meet the increasing demand for health care services in the Greater New Orleans area as part of the federal response to Hurricane Katrina, says Maria Ludwick, MPH, who serves as Interim Director of the PCASG at the Louisiana Public Health Institute (LPHI).
The grant was awarded to the Louisiana Department of Health and Hospitals and was distributed by the LPHI over a three-year period. According to Ludwick, 25 public and private non-for-profit organizations were awarded the grant based on the following qualifications: serve all patients regardless of their ability to pay, be operational and providing outpatient primary and/or behavioral health care in the four-parish Greater New Orleans region, agree to grant terms and have a long-term sustainability plan. Health care services provided by this grant were primary care, mental health treatment and counseling, HIV/AIDS treatment, and substance abuse treatments that were awarded to the New Orleans Musicians Clinic through the New Orleans Musicians Assistance Foundation.
As of December 2009, official award documents from the LPHI indicate that the clinic was granted just under $2 million in five payments over time to be used through September 2010. Yet, Ludwick says that in September 2010, the clinics participating in the PCASG, got a no-cost extension to spend funds that were still undistributed throughout the calendar year; even giving out some of the money left over from the initial grant (since only approximately $92 million of the $100 million was distributed as of December 2009). However, as time and money, began to run out from the PCASG, the NOMC had to get rid of their most expensive, yet most important, component—mental health treatment.
"We just simply couldn't afford it," Bultman says in 2010, four months before the grant was expected to run out. But, Bultman says just as the clinic began moving forward from the grant, by "rationing care and being extremely prudent," the NOMC, along with other PCASG awardees, were approved to participate in the government's new Louisiana 1115 Medicaid Waiver Program.
"Approved in September and effective October 1, 2010, this 1115 Medicaid Waiver Program aims to provide health insurance for those uninsured, low-income residents to continue to have access to the former PCASG clinics regardless of their ability to pay. According to Program Manager for the Greater New Orleans Community Health Connection, Jen Steele, one of the most important criteria to participate in this new programs was that the clinics had to be a PCASG organization. Of the 25 PCASG organizations, only 18 chose to participate in this new waiver program, the NOMC being one of them. Steele says the eligibility criteria differs from that of regular Medicaid programs: "[This waiver is a way to] let the state use Medicaid money under circumstances that normal Medicaid rules would not allow."
Patient eligibility requirements includes that you must be an adult from ages 19-64, living up to 200 percent of the poverty level (which includes up to $44,000 for a family of four; $29,000 for a couple; and $21,000 for an individual), you must be uninsured for at least six months and prove your United States citizenship and residency in the New Orleans area. According to LPHI documents, patients are initially enrolled by the PCASG clinics and are later approved by LA Medicaid. Covered services include primary care, wellness care prevention, lab and radiological services, mental health and substance abuse services. Services not covered in the Waiver include dental, optometry and ophthalmology.
However, since the Waiver was approved so quickly, Steele says that some program details are still undecided of what counts as "specialty care" as well as the program's guidelines and policies of how the money is to be distributed, which they submitted for approval in January. In fact, as of press time, the NOMC has received an initial payment from the Waiver, yet, is hesitant to use it without the official guidelines from the government.
Although the clinic is getting lump sums of money from the Waiver now, Steele says that the program is slowly transitioning from the way the PCASG worked, from large amounts of money that feel like grants, to a normal claim's process of billing and payments like Medicaid. Ending in December 2013, the goal of the Waiver is to get the provider ready for January 2014, when the Medicaid expansion and health exchanges will provide coverage for these types of patients under President Obama's Affordable Care Act.
"If everyone becomes an advocate for themselves, then, we don't have to be around anymore," Bultman says. "That's our goal."
Even though full implementation of the Affordable Care Act is fast approaching, the NOMC will still aim to provide all types of health services for the musicians (such as getting to the bottom of performance anxiety and how to help treat it) as well as petition and advocate certain government officials about preventative measures for musicians (such as banning smoke from nightclubs to prevent lung problems and lowering the decibel levels in clubs to protect musician's hearing).
For now, Bultman and Mancini say there is an ongoing grant writing and researching initiative to raise money, as well as selling benefit CDs, hosting the Creole Jazz Tea fundraiser along with being the beneficiaries from several benefit concerts put on by various New Orleans based bands and clubs around the city. ["Response has] been really good," says musician Craig Klein, who participates in some benefit shows. "It seems like a lot of people have stepped in and helped get the word out for these shows. There is no lack of great music in New Orleans. So keeping musicians healthy is an all around benefit for keeping the culture alive. Literally."
So, while things get tough with finances Bultman says the NOMC will continue to foster a "culture of caring.
"New Orleans is a city of survivors," says Mancini. "You gotta be strong and stay strong to live in this city."