Eugene “Geno” Bochenek says he needs to schedule follow-up surgery to remove some of the “hardware” doctors used to repair the broken bones he suffered when he fell stepping off an Uptown curb back in March.
Like many folks in that situation, Bochenek, 59, was fretting Friday about lining up the proper referrals from his primary care physician to make sure his insurance will pay for it.
But Bochenek isn’t like most folks. He’s homeless, having slept in a tent beneath Lake Shore Drive at Lawrence Avenue for the past year now.
This business of having health insurance is a whole new world for Bochenek and thousands of other homeless individuals like him who signed up for coverage through Cook County’s expanded Medicaid program.
Under the Affordable Care Act, better known as Obamacare, the county was allowed last year to begin enrolling all eligible adults who make less than $16,000 a year.
In the process, Medicaid was extended to a segment of the population long accustomed to either lining up in hospital emergency rooms for medical treatment or doing without.
Beginning this year, those same individuals now have the option of seeking coverage through competing managed care programs offered by private insurers and health networks.
Bochenek will be the first to tell you the county’s program, called CountyCare, has been all good from his standpoint. His surgery was performed at Swedish Covenant, one of 38 community hospitals in the county network.
“They’re taking care of me,” Bochenek said.
Bochenek said he knows he can get the treatment he needs and that the bills will be paid, as long as he puts up with the hassle of getting the referrals, which puts him in good company with many other Americans.
Bochenek isn’t usually in that company. Following a childhood with alcoholic parents in Bucktown, Bochenek says he’s spent most of his adult life in prison.
He was released about a year ago after serving three years for possession of stolen goods, and following one night at Pacific Garden Mission, decided he’d be better off sleeping on the street.
Once a hard case by his own admission, Bochenek said he’s avoided the drug use that used to get him in trouble and is determined to stay out of jail this time. Finding a girlfriend, Renee Martinez, also a former addict, has given him motivation.
“He needs somebody to be support for him, and I need somebody to be support for me,” Martinez told me in an interview at Heartland Health Outreach, which specializes in meeting the health care needs of homeless individuals.
County officials made everyone signing up for CountyCare complete a survey, and the answer to one question in particular caught their attention: “Are you worried about having a place to stay tonight or in the near future?”
Of the nearly 120,000 people who filled out the survey, 19 percent answered “Yes.”
“We found that to be relatively shocking,” said Steven Glass, executive director of managed care for Cook County Health and Hospitals. This was definitely not the typical profile of the insured.
“It’s created some interesting challenges,” Glass said.
For one thing, today’s emphasis in the medical industry on having patients recover from surgery at home looks a lot different when the patient doesn’t have a home.
To deal with that problem, CountyCare now will sometimes pay a respite care facility to house a homeless patient a few days before and after surgery, Glass said.
Bochenek says he had to go back to his tent after one night in the hospital, but did have the luxury of the county providing transportation.
Then there’s an issue with medications. Anybody who deals with the homeless soon learns their transient existence makes it difficult for them to hang on to stuff — whether that involves identification cards or clothes or a bottle of prescription drugs.
On top of that, homeless patients have proven to be among the most costly, Glass said, largely because so many are in poor health, suffering from untreated illnesses often caused by years of foregoing care.
The state of Illinois is asking the federal government for permission to use Medicaid funding to provide housing for the homeless under the theory it would keep them a lot healthier than living on the street.
Getting off the street is a priority for Bochenek.
“I was homeless twice before this and wound up back in prison both times,” he said.
If you’re thinking about what all this costs, think about what it costs to send him back to prison.