What do you do when you are uninsured and just barely getting by financially, but you are sick and need to see a doctor?For many uninsured or underinsured people in this unfortunate situation, they either go without the care they need until it becomes critical and possibly life threatening or they pay for the treatment they need and enter a downward-spiraling circle of debt that could lead to financial ruin. Not much of a choice, is it?With national health insurance still a point of debate in Washington, D.C., it may be years before some solution is found for uninsured people at the national level. But, if you live in Grand County, there is some help available right now.Grand County Rural Health Network and the Grand County Public Health Nursing Service have come up with two programs that are filling a part of the gap for low-income residents. While not insurance programs, these local programs do help children and adults with their health care needs.To be honest, these programs are baby steps in getting these people the help they require, said Jennifer Giacomini, the Community Health Program Coordinator for the Grand County Rural Health Network. But they are our local solution to the health care crisis of the uninsured and under-insured in this nation. The first of these local programs is A.C.H.E.S. (Advocacy for Childrens Health & Education Services), which is in its fourth year. It is designed to help pay for the medical costs of children ages birth to age 17 who are without insurance, Medicaid or CHP+. The children must qualify financially for the program.Basically, if the child is a member of a family of four that makes $40,000 or less, they qualify, said Brene Belew-LaDue, the Grand County Public Health Nurse. Thats about 200 percent of the poverty level designated by the Federal government. It is based on a sliding scale according to the number of people in the household. The second program, which is just getting started this year, is P.A.I.N.S. (Partners for Adults In Need of Services). It is designed do help local low-income working-age adults with their medical expenses. The same financial qualifications apply as in A.C.H.E.S. Because it is longest running program in Grand County, Belew-LaDue and Giacomini said A.C.H.E.S. has a history of success and has developed to the point that it now has two arms vouchers and vans.Vouchers for A.C.H.E.S.The A.C.H.E.S. program, which is administered by Grand County Rural Health Network, is a voucher-based system for children. Last year, 70 vouchers were awarded.To receive an A.C.H.E.S. voucher, the child must be screened first by a public health nurse or school nurse. After being screened, the family has to pay a $10 administrative fee per voucher, Giacomini said. A family is allowed three vouchers a year. For initial visits, the costs are covered.After paying that $10 administrative fee, the voucher pays up to $125 for a medical visit, $450 for a dental visit or up to $150 for two mental health visits.Anything over that amount, the provider writes off, Giacomini said. But if the child has to go back for a second visit, we dont pay unless the parents of the child qualifies for another voucher from us.Those qualifying to receive a voucher must take it to one of the designated providers/partners in the county for the medical, dental and mental health services that they need.The current list of A.C.H.E.S. providers/partners are: Colorado West Mental Health, River View Counseling, Timberline Clinic, Peak Pediatrics, Byers Peak Family Medicine, 7 Mile Medical Clinic, Winter Park Dental, Mountain Valley Medical, Granby Medical Center and Granby Dental.Voucher recipients also have their prescriptions covered under the A.C.H.E.S. program. Currently, we have two pharmacies in the county Kremmling Mercantile and City Market who accept our vouchers, Giacomini said. We pay 100 percent of the prescription price, but these are generic brand drugs that usually cost between $10 to $30.So, in effect, what someone gets for that $10 administrative fee to pay for a voucher is up to $175 worth of doctor and prescription costs, Belew-LaDue said.Belew-LaDue and Giacomini explained that one of the main goals of the vouchers is to encourge uninsured families to take their children into see health care professionals before an illness becomes chronic. What we dont want people to do is sit there with a child with a toothache or medical or mental health problem, Belew-LaDue said. The biggest complaint that medical professionals have is the misuse of emergency rooms. Too many people are waiting too long to bring their children into see a doctor, so they end up going to a hospital emergency room.By taking advantage of the A.C.H.E.S. voucher program that allows uninsured children to see physicians before their medical problems become acute, their families will not only save money on the visits, but avoid even greater expenses and loss of income.By using these vouchers, they can save a bunch of resources, Belew-LaDue said. Were really trying to help the financially strained with this program because if they miss a day of work to take care of their sick child, they miss out on the money, and thats huge for some people living in this county. That also includes small business people who if they have to close the door of their store during tourist season for a day, they could miss out on a lot of money they need to stay open. A.C.H.E.S. vansThe second arm of the A.C.H.E.S. program is its mobile medical and dental vans. These were just added last year and will continue again in 2008.Last summer, we had Rocky Mountain Youth Clinics come up here with their medical van, Giacomini said. Also, the University of Colorados Dental School sent a van up here last summer. Admittedly, these are only temporary solutions, but they helped.The CU dental van served 181 young patients during the summer of 2007 while the RMYC medical van handled 98 children.To be able to use either, the children had to have the same income qualifications as for the voucher program, Giacomini said. They still had to contact either the Network or a Public Health nurse for an initial screening.Both the medical and dental vans are returning during the summer of 2008. The schedule for the RMYC medical van is:Kremmling: Thursday, May 8 at West Grand High SchoolGranby: Friday, May 9 at East Grand Middle SchoolKremmling: Thursday, July 17 at West Grand High SchoolFraser: Friday, July 18, TBDKremmling: Thursday, August 14 at West Grand High SchoolGrand Lake: Friday, August 15 at GL Town HallGranby: Thursday, August 28 at East Grand Middle School.The services provided by the RMYC medical van includes: Well-child checks, immunizations, sports physicals, and education and referrals. The age limit for those uninsured young people wanting to use the medical vans services is 21 years old. A parent or legal guardian must accompany each child under 18 to their appointment. The cost is $10 cash per patient visit. A dental van will be back in Grand County this summer, but it will not be from the University of Coloradod Dental School.The county cannot afford the requested cost of the CU dental van this year, Giacomini said. Instead, the Network and Public Health will be working with Rocky Mountain Youth Clinics to bring their dental van to the county this year. The big difference between the past van and the one slated to come this summer is the type of treatment. Last year, the CU van provided preventative and restorative treatment. This year, the RMYC van only has the capability to provide preventative. We will be working with partners and local providers to determine alternate solutions for the restorative component in 2008, Giacomini said. The schedule for this dental van has not yet been announced.P.A.I.N.S. for adultsThe P.A.I.N.S. (Partners for Adults In Need of Services) program is for working age adults from age 18 to 64 who are without insurance, Medicaid or CHP+. The qualifications for P.A.I.N.S. is exactly the same as for A.C.H.E.S., Belew-LaDue said. But the difference between the two is that P.A.I.N.S. is only for medical vouchers.P.A.I.N.S. is also a new program, just getting started this year.This is our pilot year for P.A.I.N.S., Belew-LaDue said. We havent signed a voucher yet, but we usually get calls every week from three or four people who could use it.P.A.I.N.S. currently has five providers/partners who have signed on. They are Byers Peak Family Medical, Kremmling Mercantile, Granby Medical Center, 7 Mile Medical Clinic and City Market Pharmacy.As in A.C.H.E.S., the P.A.I.N.S. vouchers cover $125 for the medical visit with the rest being written off by the provider/partner. It also includes up to $50 for prescriptions, but the adult recipient must pay for any additional charge above that amount.We also require the $10 adminstrative fee for the voucher, Belew-LaDue said.Future of the programsBoth the A.C.H.E.S. and P.A.I.N.S. programs have solid, but limited financial support for 2008. Their funding comes from the county, towns, local nonprofits and individual donations.The Grand County Commissioners are very aware of the health care problems faced by the uninsured, Belew-LaDue said. They have donated $5,000 in grants as part of the countys budget to help both programs. Theyve given us such generous support because of the success of the A.C.H.E.S. program.Belew-LaDue commended the commissioners for their continued support, saying they really do care about rural health and the uninsured. She said they have a better handle on the health care situation than a lot of other counties in this state.Giacomini also applauded the support given to the A.C.H.E.S. program by towns such as Granby, Winter Park and Grand Lake, as well as by community organizations such as the Fraser Valley Lions Club. Right now, were looking at providing 77 vouchers for A.C.H.E.S, she said. We could do more if we had more donations, grants and local philanthropy.Despite the positive outlook for the programs, everyone acknowledges they are and can be only small efforts to address a big problem.Our programs are only a safety net for the uninsured in Grand County, Belew-LaDue said. We are working towards a grander solution.