Every working day for the past six years, Velma Koostra has helped the poor and uninsured of Warren County navigate the maze of health care programs to find low-cost prescription drugs, get glasses and regular checkups, apply for medical benefits and even schedule for surgery.

After July 4, however, those needy patients will find her door locked. She spent Friday warning some of the people who regularly depend on her.

“Today’s been pretty rough, calling some of my clients and telling them I’m no longer going to be here to assist them,” Koostra said.

Koostra is Warren County’s family health care adviser for the Kentucky Homeplace program, working out of a small office in the Community Education building on Patrick Way.

On Thursday afternoon, she got the surprise order to start shutting it down. Like the Kentucky Homeplace offices in several more of the 58 counties the program serves, it is to be closed due to state budget cuts.

The program is funded through the state, but Koostra and the other family health care advisers are officially University of Kentucky employees, she said.

“We’re just on layoff. We haven’t been terminated,” Koostra said. They’re still hoping funding will come through, but for now it doesn’t look good, she said.

That notice came with no warning, Koostra said. Knowing that Kentucky’s budget was being slashed, she and other health care advisers had been asking about their funding, and at a regional meeting in early May were told that it was assumed they’d get the same amount as last year, she said.

Kentucky Homeplace doesn’t provide health services itself, but is an advocate and connector for low-income people who don’t know where to go. Koostra said sometimes people come to her because they’ve exhausted other help, but sometimes they just don’t know what’s out there or how to apply.

Koostra said that in the past 11 months or so she’s worked with about 250 people, arranging for them to get about $300,000 worth of services. Sometimes that means vision care through the Lions Club or Lens Crafters, sometimes it’s women’s health services at the Barren River District Health Department, or referral to a few doctors who cooperate with the program. Sometimes it means filling out the reams of paperwork to verify and maintain eligibility for the myriad discount programs run by drug companies, or helping the elderly figure out the Medicare Part D prescription drug program.

“We network really well with other agencies,” Koostra said.

If someone needs medication fast, or has needs that affect health like food or help with rent and heating bills, she keeps a list of churches, individuals and agencies for emergency services - or pitches in herself, she said.

“We primarily work with health care needs, but we’ll address anything that they have,” Koostra said. “There is no place else to go for the type of assistance that I do.”

State Rep. Jim DeCesare, R-Bowling Green, said he just found out Thursday - the same day as Koostra - that the Warren County office would be closing, and has been doing some long-distance lobbying while traveling to try to get the funding restored.

“I’ve been on the phone all day, trying to find out exactly what’s going on, and I’m getting conflicting stories from a couple of different sources,” DeCesare said. He’s heard from the Cabinet for Health and Family Services that the University of Kentucky, which runs Kentucky Homeplace through its Center for Excellence in Rural Health in Hazard, decided on the cut, he said.

“That’s all I know right now,” DeCesare said. “They’re saying it’s part of the budget cuts, but this is kind of a last-minute cut.”

He sent a letter Friday urging the program’s maintenance because it affects so many people in Warren County who need help badly, he said.

Kentucky Homeplace Director Fran Feltner said she hopes DeCesare is successful in getting the funding restored. In May 2008, the program won the National Rural Health Association’s Outstanding Rural Health Program Award, she said.

Feltner said she believes the state health cabinet ordered the cut.

“UK did not make a decision to cut our program,” she said.

When Kentucky Homeplace was created in 1994, it had a $1.9 million annual budget, Feltner said. Since then it has only been cut, despite ever-rising costs and expansion of the service from 39 counties to 58, she said.

Two years ago, the budget was back at $1.9 million, but this year it’s been slashed by 4 percent, Feltner said.

“Combined with required salary, benefit increases, cost of travel and operating expenses increases from 2007, the budget now faces a shortage of $200,000,” she said.

That means the agency will have to cut seven family health care advisor positions, dropping the number of counties served to 46. Three of those jobs were vacant and had been held open to save money already, Feltner said. They served Carter County, Elliott and Morgan counties, and Livingston and Crittenden counties, she said.

But four current employees are also having to shut down their offices: the ones serving Clay and Jackson counties, Perry County, Fulton and Hickman counties - and Warren County. The offices with the lowest referral rates were tagged for closure, Feltner said.

“This was not an easy decision, considering the number of people who will go without services,” she said. In the last three years those seven offices served about 4,400 people, getting them help and medicine worth more than $12.8 million, Feltner said.

The program targets rural residents who aren’t eligible for Medicaid or Medicare and are too poor to afford private insurance. Nearly all Kentucky Homeplace clients are at or below the poverty line, she said.

“I get many referrals from many counties that we’re not even in,” Feltner said. “It’s hard to tell someone that you can’t help them with medication or needed treatment.”

Steve Nunn, a former state representative from Glasgow named by Gov. Steve Beshear as deputy secretary of the Cabinet for Health and Family Services, said that Kentucky Homeplace’s funding is just a legislative appropriation passed through the cabinet to the University of Kentucky, which decides which of its programs to fund. Ultimately, however, the loss is the General Assembly’s fault for mandating a 4 percent cut in all departments, he said.

“If they’re concerned about these programs, then they need to fund them,” Nunn said.

He knows Kentucky Homeplace has done good work in Warren and other counties, but the health cabinet can only wait on a legislative appropriation, he said.

“It’s unfortunate, but there are a lot of programs that are being cut even more,” Nunn said. “It’s just a very difficult time, and unfortunately a lot of people are going to be hurt by it. We hope the legislature will see the error of their ways by not adequately funding state government. They need to step up and be held accountable for these problems.”

Whoever’s responsible for her office’s closing, Koostra said, only prodding legislators to fund Kentucky Homeplace will keep it open. It’s been a rewarding six years in Warren County, since she could see every day that she was getting people real help, Koostra said. Now it’s a hard task to call longtime clients and tell them that help is disappearing, she said.

“So many of these people, this is the last resort,” Koostra said. “Either they get their medications through me, or they just can’t afford it.”

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