Inconsistency is pretty much the only thing Coretta Jackson can count on.
Jackson is a community health worker employed by Chestnut Health Systems, a job she’s had a little over a year. Her role with Chestnut Health is supported by a grant called the Medicaid Innovation Collaborative, or MIC, for short.
The five-year initiative is made possible through funding from the Illinois Department of Healthcare and Family Services. In 2021, Gov. JB Pritzker allocated $94.3 million for the Healthcare Transformation Collaboratives (MIC).
Three million people in Illinois receive health insurance through Medicaid. MIC is one of 10 initiatives throughout the state aimed at increasing equitable access to quality health care. Central Illinois received $5 million of the money allocated to Medicaid Innovation.
“The purpose is to bridge the health inequity gap,” said Austin Howald, Chestnut's director of integrated community services.
Several Chestnut programs fall under the MIC, including the community health worker program, food pharmacy and dental clinic.
One incentive to the MIC program involves lowering health care costs by reducing emergency room use for people in need of routine care. The community health worker initiative helps connect Medicaid recipients to a primary care physician.
“If people have regular relationships with their primary care physician, then the ER would not be (the only) option,” said Jackson, one of three community health workers (CHW) currently at Chestnut. By the end of 2023, the Bloomington-based agency would like to have a total of eight CHWs and expand service to rural McLean County. The agency also wants to expand a mobile unit that brings health care to clients directly.
ER use among unhoused individuals
Jackson specifically serves Bloomington-Normal’s unhoused population, which can complicate things.
“They may not be in Bloomington long enough to establish primary care,” Jackson said. "So, you’ll see them at an ED (emergency department) in Bloomington in April, then they’re at an ED in Champaign in March. Then come May they’re in Peoria at Saint Francis. You’ll see the pattern. Overall, the concern is these people are using emergency services for preventative care.”
At-risk McLean County residents such as the unhoused are four times more likely to use the emergency room. However, Howald said reducing ER visits is not the only goal of the MIC program.
“That’s certainly a very important byproduct of the work, but it’s really just bridging the health gap,” he said. “People that can’t get care the same way that you or I might be able to get care deserve to receive it. To that end, we’re sending the care to them.”
Other duties as assigned
Jackson is not a licensed social worker or health care provider. She does not provide treatment, counseling or prescribe medication. Her primary role is to connect clients who are either uninsured or on Medicaid to health services.
Often, this involves navigating a convoluted, confusing system — something Jackson knows about firsthand.
“I’ve been on both sides of the medical coin,” she said, “as a Medicaid patient and then now with private insurance through my employer.”
On any given day, Jackson is helping her clients sign up for Medicaid or make a doctor’s appointment. But she also looks for what she calls social determinants of health. A holistic view of health, she said, includes more than getting a physical or a dental cleaning.
“We treat the whole person, as opposed to just picking apart what our role says we’re supposed to assist them with,” said Jackson.
So at any moment, Jackson can also be securing transportation to those doctors’ appointments, finding stable housing and employment, seeking educational opportunities and job training, navigating Connect Transit, or renewing an expired Link card used for food purchases.
Jackson alternates between Home Sweet Home Ministries and the Salvation Army throughout her work week. She takes appointments from a signup sheet in the mornings and spends afternoons at The Junction, a free community center across the parking lot from Home Sweet Home. Some mornings are busy; others are not. On this particular morning, she has just one appointment, with a woman named Amanda.
“I was looking for what kind of programs you guys have,” said Amanda, who asked that her last name not be used. “I need to work on getting my Link card renewed. I’m looking for a job — just getting myself back on my feet as fast as possible.”
Amanda arrived in Bloomington several months ago after fleeing a domestic violence situation. After a few questions, Jackson tried to get into Amanda’s account online to renew her Link card. Amanda pulled out a few clothes, a toiletry bag, and a bible to get to her wallet at the bottom of her backpack.
After about five minutes navigating a confusing menu of options by phone, the two women decided going in person to renew Amanda’s benefits might be the best option. She felt strongly about connecting with a doctor to address chronic health issues related to the abuse she endured. Encountering patient bias
Jackson said a perpetual challenge is ensuring that once her clients are connected to health care services, they are treated fairly. Medicaid recipients face challenges people with private insurance are less likely to encounter.
“There are four managed care plans in Bloomington-Normal,” Jackson said. “One of those plans is only accepted by one provider in Bloomington. So, that’s already telling everybody else with Medicaid at that provider’s office, you’re not welcome.”
That is especially true for unhoused individuals on Medicaid.
“There’s literally nowhere else to go but up, but it’s hard to go up when you’ve got people with their hands down,” Jackson said. “A lot of my clients experience that with having Medicaid. It feels like they’re being held down and held back from being able to progress physically.”
Even the providers who take Medicaid may not treat all patients the same, she said.
“There’s a difference in care,” Jackson said. “There is a difference in how patients feel when they arrive to the clinic. A lot of them don’t know what services they are owed.”
Jackson adds that asking for and receiving help is difficult for many people. For her, a win is walking into a doctor’s office and seeing a former client managing their own care.
“That is a huge thing, having the confidence to know that, in reality, we as patients run the doctor’s appointment,” she said. “The doctor might be the expert on the condition, but you’re the expert on you and your body.”
The psychiatric care gap
People in need of psychiatric care face a significant mental health gap in McLean County.
In a 2022 Community Health Needs Assessment, McLean County Community Health Council selected behavioral health as a top priority. And among the unhoused, mental illness rates are double that of the general population. According to the American Psychological Association, people with substance and other mental disorders experience even greater barriers to accessible housing than their counterparts, including income deficits, stigma and need for comprehensive community services.
That’s where Jackson comes in.
“I’ve come into situations where I’ve had clients who have not had psychotropic medications for seven, eight, nine, 12 months,” Jackson said. “They know their triggers. They know what their limits are in terms of socialization.”
Jackson recounted an experience with one client, who asked the shelter staff to stay in his room, fearing symptoms of his mental health disorder that are exacerbated by social environments.
“They didn’t listen,” she said. “I currently don’t know where this man is.”
Strength in the successes
Recently, Jackson visited Parrish Phillips at Arcadia Care Bloomington, a nursing home where he is recovering from hip replacement surgery.
Parrish is from St. Louis. He first came to Home Sweet Home Ministries in October and couldn’t walk without severe pain and use of a cane or walker. When he met Jackson, he had two main goals: Get a hip replacement and find a place to live. He wants to be able to play with his grandkids. And he wants to do it in his own home. This is his final follow-up appointment with Jackson.
“Three weeks into Home Sweet Home, Coretta came through,” Phillips said. “She advocated for us to get insurance. She went to bat for me.”
Phillips was stuck in a kind of insurance black hole. After a nearly three-hour phone call, Phillips went from being uninsured to being covered by both Medicare and Medicaid. And now, Phillips can stand and walk about the room, with a spring in his step that could perhaps be characterized as swagger.
Moments like this are what keep Coretta Jackson motivated to advocate for her clients, but she knows there is a long way to go. The gaps she and Parrish uncovered in that three-hour phone call are not altogether uncommon. A doctor’s office might make calls, send letters and emails to patients reminding them about an appointment, for example, but unhoused or transient individuals may never receive them.
“You can’t just say, well, they ignored our letters. People love to say, let’s meet people where they are, but medically in Bloomington-Normal, if we’re meeting people where they are, we need to take a few more steps.”
There are silver linings. According to Jackson, Parrish Phillips is healing faster than anticipated and “relishes in being pain free.” He has several leads on an apartment in preparation for leaving the nursing home.
Amanda has secured steady employment and has an upcoming appointment to establish a relationship with a primary care physician. Her goal is to eventually study geology and work for NASA, a passion she discovered searching the internet at The Junction.
Chestnut Health Systems is actively hiring community health workers. Anyone with a high school diploma or equivalent is encouraged to apply; selected applicants will receive on-the-job training.
