May 3--A three-story building in midtown dispenses what might be the best health care for Sacramento's uninsured.
The Center for AIDS Research, Education & Services, or CARES, offers a comprehensive set of in-house services, including primary care, dentistry and mental health. The services are free for the uninsured; there might be a small co-payment for the insured.
The catch is, it is only available to people diagnosed as HIV-positive.
"We have been fortunate," said executive director Bob Kamrath. "We have not cut services. We've added services."
CARES has thrived because a steady flow of federal dollars is the nonprofit's lifeline.
Facing diminished local and state funding for health services, other nonprofits are starting to turn to the CARES model as well.
Over the past several years, Sacramento County has slashed its primary care clinics budget by almost half, and has gone from six full-time clinics to three, and soon one.
"The paradigm has shifted away from counties being the core anchor to the safety net system," said Bob Caulk, executive director of The Effort. "In the future you're going to see a different arrangement of safety net operations, funded by federal dollars."
But the issue with federal money is that oftentimes it can only be used for a very specific purpose.
CARES takes advantage of this in two ways. First, it receives $3 million annually under the $2.55 billion-a-year Ryan White Care Act, which gives money for uninsured people with HIV or AIDS.
Second, CARES operates an on-site pharmacy, which allows it to tap into the federal 340B Drug Pricing Program to purchase reduced-price prescription drugs. That nets about $6 million a year.
Federal money makes up 80 percent of its budget: The remainder comes from health insurers and Sacramento County, which pitches in $250,000 a year.
With this money, CARES is able to carefully tend to patients.
New patients first see a benefits counselor, who sets them up with a primary care physician, and if needed, a psychiatrist or therapist. Patients with substance abuse problems are referred to an addiction specialist and support groups. Or they might stop by the dentist's office for a teeth cleaning.
On their way out, they stop by the CARES pharmacy, which fills 475 prescriptions a day.
"The only thing we don't have here is specialty care -- podiatry or something like that," Kamrath said.
Clients have had video chat appointments with UC Davis dermatologists.
CARES serves about 2,100 HIV-positive people in the region, a very small portion of the chronically ill.
According to newly released data from the California Department of Public Health, in Sacramento County between 2006 and 2008, cancer killed an average of 2,236 people a year; coronary heart disease 1,907; flu 301; and suicide 178.
As for AIDS, there were 81 new cases per year on average.
CARES says it's doing some mop-up work for the county. In 2008, it began offering walk-in testing for sexually transmitted diseases at the county's request.
Patients say there's no telling what would have happened to them without CARES.
Maurice Belvin, 53, has been coming for nearly 20 years, after a drug habit led to full-blown AIDS. He sees a doctor every three months who checks on his HIV, but also admonishes him on his diet and lifestyle choices. Through addiction classes and routine care from CARES, he has been able to keep AIDS, as well as his cholesterol, in check. He pays about $120 a month for care and prescriptions.
"It's a one-stop shop," he said. "I get everything from dental care to anger management classes."
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Call The Bee's Anna Tong, (916) 321-1045.
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