When Jesus Jimenez brought his family into Lirios Pediatrics in April, it was just like any run-of-the-mill checkup. His 11-year-old son squinted at an eye chart, while his 12-year-old daughter stood straight and still as a nurse recorded her height. By the time they left, they’d also received standard school vaccines.
The appointment was hard to come by. The Jimenez family is uninsured, and out-of-pocket costs for medical care can be prohibitive. But the kids needed vaccines for school. A neighbor told Jimenez that Lirios serves uninsured kids for free, so he made an appointment.
“I don’t have the resources to pay for vaccines right now,” he said in Spanish. “Without them, they won’t let my kids learn.”
Lirios is the passion project of Dr. Claire Hebner and Monica Simmons, a pediatric nurse. The two women opened the clinic in 2022 with a goal of serving children who “fall through the cracks” of Texas’ health care system. They believe it's the only free clinic in the state that exclusively serves uninsured children.
Simmons, who also serves as executive director of Lirios, said many of the families who end up at Lirios are motivated by school vaccine requirements, like the Jimenezes. Others want a prescription for a sick child. Whatever brings them through the door, Lirios budgets 45 minutes for an appointment that includes a standard physical exam.
Patricia Lim
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KUT News
“Just like any pediatrician’s office, we're going to do their heights, their weights, their vital signs," Simmons said. "Make sure that they're growing, developing appropriately, that they can see, they can hear."
What sets Lirios apart is the staff’s attention to other needs that might present. Some patients struggle to get enough food, so they’re sent home with a week’s supply and connected with a food bank. There’s a closet with bags of clothes and hygiene kits. Lirios also has donated drugs on hand so folks don’t need to make a trip to the pharmacy. A mental health counselor is available, too.
“We try to give them some resources that will help them be OK today,” Simmons said.
Meeting evolving needs
Around 854,000 Texas children were uninsured as of 2022, according to a study by Georgetown University’s Center for Children and Families. These accounted for 22% of uninsured children in the United States.
Since opening its doors in December 2022, Lirios has served more than 1,000 of those kids.
“When we first started, there were several people that said, ‘Why are you doing this? It’s not needed. Kids have health care,’” Simmons said. “There’s a lack of awareness about the children that are falling through that gap.”
Children from low-income families in Texas do often qualify for Medicaid or the Children’s Health Insurance Program (CHIP). Travis County residents can also apply for the Medical Access Program, a benefit offered by the public hospital district Central Health that's intended for people who are low-income but don’t qualify for Medicaid.
Patricia Lim
/
KUT News
But there are still legions of families who make too much to qualify for these programs and yet struggle to afford traditional insurance. Many of Lirios’ patients are also immigrants and refugees who may not qualify for Medicaid because of their immigration status. Lirios doesn’t ask them to share any documentation about their status, which Simmons said removes a barrier to care.
“That’s one of the benefits we have, is we don’t have to ask,” she said. “We ask if they’re uninsured, and we ask if they’re under the age of 19.”
Simmons said she has seen a gradual shift over the past few months in the makeup of patients visiting the clinic, however, with more families coming in who have lost access to Medicaid only recently.
Most states, including Texas, saw improvement in their uninsured rates between 2019 and 2022. Federal policy had kept Medicaid participants continuously enrolled in the program during the official COVID-19 public health emergency. The Texas Health and Human Services Commission reports that the state’s Medicaid rolls grew from around 3.9 million to around 6 million people then.
But states were ordered to begin reassessing Medicaid eligibility for everyone enrolled during the continuous enrollment period starting in April 2023. Since this “unwinding” process began, Texas has removed more than 2 million people from Medicaid, including more than 1.3 million children. The majority of those removals were procedural, meaning recipients were removed due to issues like missing paperwork. HHSC also acknowledged that some denials occurred in error.
Simmons said she has seen the effects of this process at Lirios, with families trickling in who had no idea they had lost their Medicaid benefits until trying to make a doctor’s appointment.
“There's something about that that isn't working for all of these families," she said. "Somehow they're not getting the notice, or they didn't realize they were uninsured, or that they had to fill out paperwork."
Finding sustainable coverage
Some of these people might still qualify for Medicaid, but it will take time for them to reapply and get reapproved. Until then, they can go to Lirios.
The clinic has a vested interest in encouraging families to apply for insurance programs. For one thing, insurance opens doors for more specialty care options and lessens financial stress in true emergencies. For another, there are always more kids waiting to be seen at Lirios; typically, patients have to wait around five weeks to get on the schedule for a basic well-child checkup, although Simmons says they can usually squeeze in a sick patient quicker.
“We don't want these kids to be uninsured," she said. "We don't want them to have to need us, but today they do, and so we're going to do our best to take care of as many of them as we can."
