For those unfamiliar with the lottery system used to take in new patients at Arlington Free Clinic, it’s an exciting and rewarding process – but I didn’t fully appreciate everything involved or at stake until I was given the opportunity to help with the lottery as an intern this summer.
Since about 2008, the lottery has been the primary system used by AFC to register new patients. The number of people who can come in through the lottery varies from month to month based on AFC’s capacity. Usually, 70-90 prospective patients attend, and the Clinic can take in about 25 (an additional 20-25 people are accepted via direct referral from Virginia Hospital Center or local safety-net organizations every month).
Sometimes, AFC is able to accept more new patients than in a typical month. I saw this happen over the summer, when interns were around and able to bulk up the staff’s administrative capacity (every new patient goes through a comprehensive eligibility screening before they can see a provider). AFC also had extra space following the Affordable Care Act’s Open Enrollment Period, when the Clinic helped to transition about 150 eligible patients onto their own insurance plans, thus creating room for more brand new patients who weren’t eligible for any of the ACA-health care options.
If you stop and think about the reality of the lottery, every month there is a line of people extending around the side AFC’s building, hoping that their number will be drawn and that they’ll gain access to the type of top quality, comprehensive care that simply would not be accessible to them otherwise. You don’t stand in line for the chance at health care unless you suspect or already know that something is wrong, and that’s a very scary space to live in when you don’t have health insurance.
The lottery always attracts more people than the Clinic has the capacity for, and it is with regret that AFC can’t take in everyone. Nevertheless, the mood during Lottery Day is never sad or upsetting: I watched the entire room clap for and congratulate the newest member of the Arlington Free Clinic medical home every time someone’s number was chosen. For those not chosen this month, a team of staff is ready to provide other options: local low-cost clinics; a free mammogram program administered by AFC and aimed at women age 40+ (anyone whose mammogram yields abnormal results automatically becomes AFC’s fulltime patient and is immediately connected with pro bono treatment including surgery, chemo, and radiation); and encouragement to return next month because every time that you come to lottery, you are given an extra number and increase your chance of being accepted.
The lottery, which takes place on the second Tuesday of every month, is AFC’s way of trying to fairly extend care to the entire community over time, while up against the reality of limited capacity and resources. It would be great if AFC could accept everyone who showed up seeking care; understanding that some people will not get in is hard. But the lottery allows AFC to provide timely, top quality services at the breadth and depth that patients, who often come to the Clinic with multiple long-untreated chronic conditions, need.
-Allysen, Summer Development Intern