It was a rare sunny day in this long, gray winter, and Anita Denson thought maybe that would bring some people in.
But as 1 p.m. Friday turned to 2 p.m. and then to 3 p.m., Denson sat in her office at Lexington's Bluegrass Community Health Center catching up on paperwork and answering the occasional call.
The walk-ins she'd hoped for just didn't come.
Somehow, despite the efforts of both the clinic and the state, many people aren't aware that they might be able to sign up for Medicaid or low-cost private health insurance because of the Affordable Care Act, Denson said.
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"Somehow they just haven't put it together," said Denson, who has worked to help people enroll since the rollout began Oct. 1, 2013.
March 31 is the deadline for the uninsured to private insurance or face a fine under the Affordable Care Act. People who are eligible for Medicaid, which is based on household income, can continue to enroll after the deadline.
Kentucky, which created the website Kynect.Ky.Gov, has been touted as a model for enrollment. When it started, an estimated 640,000 Kentuckians were uninsured. By the end of February, 265,000 people had signed up for insurance. But the percentage of uninsured varies greatly from county to county. Perry County had the highest at 67 percent. In Fayette County, about 24 percent of the 47,000 uninsured residents have signed up.
In addition to Denson, who spent most of her time helping people enroll, 10 other staffers have been trained to use the Kynect system, said Susan Fister, executive director of Bluegrass Community Health. Her agency doesn't have a large budget for advertising, she said, but it has spent about $4,000 on radio and other advertisement aimed at reaching the uninsured.
The agency's staff also has made more than 3,000 automated calls to clients who were uninsured but would not qualify for Medicaid. They've also held Saturday enrollment clinics, but those attracted only a handful of people. HealthFirst Bluegrass, a clinic similar to Bluegrass Community Health, also has held Saturday hours and is encouraging walk-ins. HealthFirst has signed up about 1,400 people, including 700 current patients.
UKHealthCare has trained more than 50 employees to assist with sign ups and have helped 1,500 Kentuckians enrolled, spokeswoman Kristi Lopez said.
Although she has been in touch with peers running similar clinics around the state, Fister said she still isn't sure how to get uninsured residents to enroll.
I don't know what the variable is," she said. She's concerned that things are moving more slowly in Fayette County than in other parts of the state.
Certainly the need is no less here, she said.
Fister helped one man enrolled who had untreated diabetes, she said. He had been without care for so long his toe was necrotic and had to be amputated. But, she said, he now has insurance and can get the medicine and care he needs.
A majority of the health clinic's 8,000 patients would be eligible under the state's new expanded Medicaid guidelines which raised the amount of money a family could make and still sign up for the program, she said.
She thinks a percentage of eligible patients may have tried to sign up previously, before the income guidelines changed, and still assume they are not eligible.
Denson wants people to know her door is open and she is willing to help. Though the state system is working well, when there is a glitch, it can sometimes take a while to get things fixed, she said. She has spent as long as an hour and a half on hold trying to reach the state Medicaid office, because they are inundated with calls. That's especially true during the first two weeks of the month when people who are already on Medicaid must reenroll each year.
But, she said, it's worth the effort when she gets to tell somebody "you're approved."