There are an estimated 70,000 uninsured adults in Pima County, 52 percent of whom are Hispanic. Two-thirds of these uninsured adults are low-income working adults, and 84 percent of the uninsured are workers or members of a working family. Approximately 30 percent of employees in firms having one to nine workers have no insurance. In Arizona, 99 percent of full-time business firms with employees are small businesses.

Therefore, in 2001, El Rio brought together representatives of area hospitals, health centers and clinics, individual physicians, and the Pima County Medical Society to address the high percentage of the uninsured among the “working poor,” those who earn an income too great to qualify for AHCCS but who cannot afford traditional health insurance premiums. The program is available to area business owners to provide benefits to their workers who qualify. The program bridges the health care gap for thousands of working people over the age of 18 whose income is up to 250 percent of the FPL and who are ineligible for any other form of traditional insurance.

PCAP runs on the goodwill of the provider community. A network of area providers offers deep discounts for services, a medical home, and coordinated care for participants. Primary and specialty care, as well as hospital services, are included.

Participants pay an enrollment fee of $20 twice a year to participate. Beyond the enrollment fee, participants pay only when they use services. Most primary care is provided on a discounted sliding fee scale. A specialist consultation is $25. Specialty treatment costs 30% of what Medicare would pay for that treatment. If a member needs to be admitted to a hospital, it costs $400 a day for medical/surgical care and $600 for intensive care, with a maximum of $2000 for any hospital stay. Prior authorizations are not required, and there are no insurance forms to fill out or insurance plan requirements to meet.

Since the beginning, El Rio has assumed a leadership role in designing and implementing PCAP. El Rio hosts and coordinates PCAP. We provide all fiscal and administrative support on an in-kind basis. Seven area clinics, six hospitals, and over 500 private health care providers are providing health care services to more than 7,000 PCAP members.

Results of a recent satisfaction survey of members and providers indicate that 97 percent of those surveyed were highly satisfied with the program. Utilization data for the first year, in comparison to similar populations with coverage ranging from public insurance to a commercial HMO, documented equal to lower utilization rates. These results suggest the success of PCAP in redirecting participants to early treatment and preventive care. When individuals have access to comprehensive and coordinated services, they receive appropriate care at the appropriate time at the appropriate place.

For additional information about PCAP, please visit their website at:
http://www.mypcap.org/index.php or you can call them at (520) 694-0418.