Columbia River Mental Health program fills medical gap, reaches out to homeless

Paul Hunter, a homeless former carpet layer, had legs so swollen he was having trouble walking. The wounds on his legs from drug use were turning black. It was only a matter of time before he’d end up in the hospital.

But he didn’t.

Medical professionals with Columbia River Mental Health Services’ GAP Medicine Care program cleaned and dressed his wounds, making small talk to put him at ease as he was treated.

GAP stands for Greater Access & Prevention. If not for the program, Hunter might have had to wait months to find a doctor who would take Medicaid, or he might have ended up in the emergency room.

“This whole team exists because of these gaps,” said Dr. Kevin Fischer, chief medical officer at Columbia River Mental Health.

GAP Medicine Care is one of the few providers in Clark County that will accept new Medicaid patients for primary care. Created in 2022, it’s the only way many homeless people, who are more at risk for health issues, can access medical care.

“There’s just a huge lack of availability,” said Kurt Kenoyer, a physician assistant with the program.

Limited help

In 2010, then-President Barack Obama signed into law the Affordable Care Act, a facet of which expanded Medicaid eligibility. Suddenly, thousands more people were eligible for care in Clark County. Medical providers were not prepared for the change, Fischer said. They needed more staff and more funds. But reimbursement rates didn’t keep up with demand.

“It’s very challenging with the levels of reimbursement that you can get for Medicaid to provide care … that doesn’t result in significant financial losses,” Fischer said. “And a clinic has to be able to break even to operate.”

The Columbian called the Vancouver Clinic, Legacy Health, and Providence Health & Services in Clark County. None is accepting new adult patients on Medicaid.

“It creates a natural challenge where many people just have unmet needs. And so that’s kind of the idea of GAP Medicine,” Fischer said. “Our patients face gaps, and how can we fill those gaps?”

Around 27,000 people in Clark County are Medicaid patients. Homeless people often need frequent care because living outside makes them more vulnerable to the elements, stress, depression and assault, according to the Substance Abuse and Mental Health Services Administration.

“That’s going to put a lot of stress on you, and it can put stress on your heart,” Kenoyer said. “It can affect your sleep and affects your appetite. … All of these stressful circumstances just raise your blood pressure.”

More than 9,000 people were homeless in Clark County in 2022, the most recent numbers available, according to Council for the Homeless. A new tally is expected this month.

Rebuilding trust

One of the most important parts of the program is it rebuilds trust between homeless people and medical professionals, said Courtney Loy, a nurse with Columbia River Mental Health. Many of her clients have had poor experiences in traditional health care settings, where they’re not a doctor’s average client.

“Not everybody gets into medicine to deal with clients with mental illness and addiction and homelessness issues. So I think there’s a lot of preconceived notions of clients,” Loy said. “I think we automatically approach it with more heart because it’s what we want to do.”

Loy doesn’t look like other nurses. She prefers jeans and a sweatshirt to scrubs and is often found on sidewalks or in Columbia River’s small clinic, 6926 N.E. Fourth Plain Blvd.

While others might be waiting months for an appointment, people often show up unexpectedly at the clinic or call Loy’s team from across the street.

“It’s pretty casual. When we go out, we talk to people, try to get to know them,” Loy said. “They’re willing to actually seek out care.”

Specialized care

GAP Medicine caters to those who fall between the cracks in mainstream medical care, Loy said.

Homeless people often don’t have phones to make appointments and struggle to find reliable transportation. Those coping with mental illness or addiction may have trouble remembering appointments or caring for themselves, Kenoyer said. GAP Medicine doesn’t charge for missed appointments.

The program takes most insurance plans and offers rates on a sliding scale, so people can secure the care they need without further financial hardship.

But GAP Medicine can help only with acute and chronic medical care, even though many people in Clark County’s homeless camps and shelters have more serious health issues such as cancer and heart problems.

Still, staff say they can treat wounds, diabetes and high blood pressure. They can also treat mental health and addiction by providing medication and connections to Columbia River Mental Health’s therapists.

Serving this population comes with many challenges, Kenoyer said. During a Wednesday meeting, the medical professionals talked through issues their clients face. One person who sleeps upright in a car is struggling with swelling legs while trying to heal wounds. Another has no way to refrigerate their insulin. Others consistently have their antibiotics stolen in camps.

It’s often hard to find people for follow-up care when they have no contact information and move frequently, Kenoyer said. But these are hurdles he’s willing to jump if he can help some of the people who need care the most.

“They’re in circumstances that are beyond their control,” Kenoyer said.