Dickinson-Iron County Critical Health Indicators

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Access to Care:                                                                                        

MIChild, Healthy Kids, Dental Access, and D-I County Medical Access                                                                                          

What Is It?

Healthy Kids is Michigan's Medicaid program for children whose family income is below 150 percent of the federal poverty level. Along with the introduction of MIChild, the Healthy Kids program expanded eligibility for children through 18 years of age to 150 percent of the federal poverty line. Children under the age of one and pregnant women with family incomes up to 185 percent of the federal poverty line are covered.

This indicator measures the number of children enrolled in MIChild and Healthy Kids at a point in time each month who, in most cases, would otherwise not have a medical home and access to many health care services.

MIChild and Healthy Kids: Access to health care for low-income children

How are Dickinson and Iron Counties doing?

As of October 30, 2001, Dickinson County has 114 children and Iron County 78 enrolled in MIChild. And, as of January 1, 2001, 1,395 children have been enrolled in Healthy Kids in Dickinson and 792 in Iron County.

How is the State of Michigan doing?

Michigan is a national leader in providing insurance for all age groups and ranks among the top eight states with the lowest number of uninsured children. Michigan's new health insurance initiative, MIChild, provides health insurance to children of low and moderate-income families. Children under the age of 19, without health coverage, whose family income is between 150 and 200 percent of the federal poverty line are eligible under this initiative. The MIChild program, which started in May of 1998, provides Michigan children a comprehensive health plan for the modest cost of $5 per month per family. MIChild enrollment is coordinated with Healthy Kids enrollment and both programs share a single application.

Enrollment in MIChild and Healthy Kids has risen steadily. For MIChild, enrollment has risen from five children in May of 1998 to 13,334 as of January 1, 2000. For Healthy Kids, enrollment has risen from 161,135 to 242,913 children during the same time period.

What other information is important to know?

Children with a medical home are more likely to receive preventive services and health education, less likely to miss school because of illnesses, and less likely to use the emergency room. The focus of Healthy Kids is to provide Medicaid-eligible children of low-income families with a medical home and access too primary, preventive, and other health care. When MIChild legislation was passed by the Michigan Legislature, it included an expansion in the eligibility of Healthy Kids, as noted above, for the children of low-income families.

What is the Dickinson-Iron District Health Department doing to affect this indicator?

The DIDHD is enrolling families, pregnant women and children in Medicaid and MIChild through an extensive outreach program; staff attends State provided training to stay up to date on the latest department changes. DIDHD accepts all referrals and works with families to submit completed applications. Information and Medicaid and MIChild applications are available at all community events in which staff participate. DIDHD and the Dickinson and Iron Collaborative Boards are active participants in the U. P. Advisory Coalition Covering Michigan's Kids.

Dental Access

Dickinson and Iron Counties have been designated as low-income population group dental Health Professional Shortage Areas.

How is the DIDHD doing?

For many years, low-income children were not provided dental care for a variety of reasons. Orthodontic work in the Upper Peninsula has been difficult to procure and the use of the University of Michigan required for many families a 500 + mile trip. Issues of dentists not accepting new Medicaid patients created a tremendous void for Dickinson and Iron County low- income citizens. Individual health professionals frequently intercede in Medicaid payment issues to insure service is maintained.

To increase access, the DIDHD assisted in developing a dental clinic in Iron County which began seeing patients in 1997 under the auspices of the U.P. Association of Rural Health Services. This dental clinic has provided preventive care for our low-income children which previously was travel prohibitive.

The success of the current clinic program in Iron County has been significant in providing needed dental services to children in Iron and Dickinson County. The need for these services far exceeded the capacity and distance to the closest clinic in Powers. The Iron County Clinic sees both adults and children.

How do Dickinson and Iron County compare with Michigan and the U.S.?

Access to dental care is a problem nationwide. For example, about 125 million Americans do not have any dental insurance. Furthermore, 81 percent of nursing home residents have not had a dental visit in the past year, and 80 percent of children on Medicaid have not had a preventive dental visit in the same period. Finally, 38 percent of rural counties have no dentist, and 62 percent do not have a dental hygienist. (1) Only about a third of the eligible adults and children on Medicaid (low-income) have received dental care. With the addition and expansion of dental services to this population in Iron County, we are treating a significant new percentage of the children. It is hoped that by the end of the decade (2010) nearly all low-income adults and children will be receiving dental care. This will greatly enhance the quality of lives for individuals now suffering a lack of dental care. Besides our local Dentists, our low-income populations have these other resources within a large geographic area:

NORTHERN MENOMINEE HEALTH CENTER

EAST US 2

SPALDING, MI. 49886

(906) 497-5205

DICKINSON-IRON DENTAL CENTER

211 SOUTH FOURTH. STE. B-1

FALLS CLINIC

CRYSTAL FALLS, MI. 49920

(906) 875-6133

EWEN DENTAL CLINIC

644 PINE STREET

BOX 260

EWEN, MI. 49925

(906) 988-2468

MARQUETTE DENTAL CLINIC

989 W.WASHINGTON STREET SUITE 104

MARQUETTE, MI 49855

(906) 226-9992

SAWYER DENTAL CLINIC

301 EXPLORER STREET

GWINN, MI. 49841

(906) 346-4367

(ALL THE ABOVE ACCEPT MI-CHILD, HEALTHY KIDS AND MEDICAID)

WESTERN U.P. DISTRICT HEALTH DEPT.

DENTAL PROGRAM

540 DEPOT STREET

HANCOCK, MI 49930

(906) 482-7382

(ACCEPTS UNINSURED K-8TH GRADE ONLY)

Dickinson -Iron County Medical Access

It is estimated that 4,388 (16%) of Dickinson County residents and 5,181 (39.6%) Iron County residents are unserved by not having access to a medical care provider. In addition, it is estimated that 3,234 Dickinson County residents do not have health insurance. In Iron County, it is estimated that 1,631 residents are without health insurance.

Many of our residents must travel long distances for specialty services or options to specialty services. The nearest tertiary care facility, Marquette General Hospital, is an eighty-mile drive. Green Bay, Wisconsin hospitals are 100-150 mile drives. A large number of residents travel to Marshfield Clinic in Wisconsin or Mayo Clinic in Minnesota. Hospital services as far away as Green Bay, Wisconsin are considered borderland providers for Medicaid purposes. Transportation to out of area service providers is difficult to procure.

In recent years the 97 bed primary care hospital and emergency department at the Dickinson County Healthcare System has been able to recruit a substantial number of specialty physicians and develop or expand services. New laboratory and diagnostic equipment has been added as well as a Sleep Disorder program. Many new services such as oncology are joint ventures with Marquette General Hospital. Additionally a Pain Diagnostic clinic in Niagara serves the area.

Iron County Hospital, a 71-bed primary care hospital and emergency department, has closed its obstetric unit. Iron County Community Hospitals, Inc. is the consolidated corporation of Crystal Falls Community Hospital, Crystal Manor Nursing Home and Iron County General Hospital.

The hospital has also been successful in the recruitment of specialty services and has expanded their services. Outpatient chemotherapy, neurology, rehabilitative and diabetes education, dialysis and a specialty clinic are among these services. Additionally, the Greater Iron County area is now served in emergencies by Advanced Life Support Services.

Currently there are 35 (1999) primary care physicians in Dickinson County and 9 primary care physicians in Iron County. Many physicians from Green Bay and Marquette also serve the two county areas on a rotating appointment basis.