A pre-storm survey identified more than half of St. John residents as uninsured, and nearly three quarters of residents do not have health insurance that covers primary/preventive care. Since the storm, several of the major employers that offered health insurance have not returned. In a post-storm survey, one-third of respondents indicated that they do not get their basic health care needs met on St. John because they have “No insurance or insurance doesn’t cover.”

Some residents are only able to get stateside insurance that is not accepted in the Virgin Islands. Openended responses indicated that some respondents are able to get their basic health needs met on St. John because of Island Health & Wellness, a nonprofit medical provider that offers services at a low flat-rate fee. The annual income eligibility for Medicaid in the USVI is very low: $6,581 for a single person household and increases by $2,292 per household member. The federal funding for Medicaid to the territory is capped – meaning that not everyone who is eligible for Medicaid may be able to receive it. The only private practice on St. John, Cruz Bay Family Practice, is able to offer the full scope of medical services for all ages, prenatal to geriatric. They accept Medicare and can offer discounts and payment plans for those in need, but there is still a large uninsured population that cannot afford this option, as well as many residents with stateside insurance plans that are not accepted or not in-network at providers in the territory. Morris F. DeCastro Clinic, a public health facility in Cruz Bay, and Myrah Keating Smith, a division of the Schneider Regional Health Center public hospital on St. Thomas, are both able to accept Medicaid. In the wake of the hurricanes, these two facilities are sharing an overcrowded location. Pediatric services are offered the last Friday of every month. This project seeks to identify the gaps in the ability for on-island providers to offer affordable services to everyone. A gap that was identified in the planning process is pediatric care. Island Health and Wellness does not have a pediatrician on staff, so while adults are able to access affordable health care at this location, children are not. Island Health & Wellness has pursued options to be able to offer pediatric care, but more work is needed to make that a reality. Another gap is for patients that need specialized care or lab work the goes beyond the scope of what can be provided at a primary care office. The St. John Revolving Fund Charitable Trust offers a revolving loan program for medical expenses but needs to be expanded due to increasing needs post-storms.

IMPLEMENTATION STEPS: 1. Continue to recruit a pediatrician to work at Island Health and Wellness or to be a sponsor for that location. Identify funding for this position. Possibly make use of the National Health Service Corps Loan Forgiveness Program as a recruiting tool. 2. Continue to seek creative solutions or partnerships to provide pediatrician services at Island Health & Wellness. 3. Review the revolving loan fund and redevelop bylaws/support the board of directors as necessary. Pursue additional funding to meet the increasing needs of Island residents.

Key Player: Island Health & Wellness Alignment: HHS RSFs Cost: < $100,000 Timeline: < One Year