Ilene Lindsey was just 45 years old when her health problems began: spinal stenosis, a major heart attack, black foot, diabetes, and Ramsay Hunt syndrome, a rare complication of shingles that causes facial paralysis. The illnesses began 15 years ago and just kept coming, one after another. Lindsey and her husband, Carey, would barely have time to recover from the stress of one when another would arise.

They ran a restaurant and lounge called Little Bit and More in Story City, but a few months into Ilene’s health crisis, they lost it to bankruptcy. Then Carey, who had worked as a bricklayer before opening the business, spent several years doing electrical work on a contract basis and trying to pay for private health insurance.

They couldn’t keep up.

"Every time Ilene went into the hospital with another problem, our premiums would go up," Carey says. "I was constantly worried about her and about how to pay for all her prescriptions."

Sometimes Ilene tried to talk Carey out of buying the medication she needed because, she says, it didn’t make sense to use all their money for pills when they barely had enough to eat. But he was devoted to her, often going into debt in order to pay for her care.

A year and a half ago, everything changed for the Lindseys. That’s when Carey, desperate to find assistance before he and Ilene lost everything, heard about the Indigent Patient Care Program (also known as the "state papers program") at University of Iowa Hospitals and Clinics.

This program works in partnership with the state of Iowa to ensure that chronically ill and indigent Iowans receive health care. Every Iowan who receives state papers as part of the Indigent Patient Care Program is eligible to receive medical and surgical services at the University at no personal cost. State papers are awarded according to the guidelines of county general assistance offices in each of Iowa’s 99 counties.

Each year, about 3,500 patients receive services at University of Iowa Hospitals and Clinics on the state papers program. Many receive personal assistance from a case manager with the Care Management Program, a service provided under the auspices of the Indigent Patient Care Program. Through the program, nurses coordinate patient care, assist in setting up multiple appointments, and provide links to resources when questions about medical or pharmaceutical issues arise. This program even arranges transportation to and from University of Iowa Hospitals and Clinics for indigent patients and has successfully increased patient satisfaction and outcomes while reducing resource utilization. It’s worked wonders for the Lindseys.

Both Lindseys qualified for the Indigent Patient Care Program through Story County’s General Assistance Office. Because Ilene’s medical needs are so complex, she was referred to the Care Management Program. Carey says access to quality medical care has relieved them of their greatest stress. But the relief isn’t just due to the financial help they receive. What matters even more, he says, is the way the Care Management Program delivers service to its clients.

"When we first came to the University hospital on state papers, I thought everyone would be looking down their noses at us," Lindsey says. "But we’ve never ever seen a hint of that. These people greet us at the door like we just handed them a million dollars. And that’s everyone: the receptionists, the nurses, and the doctors."

If they had to thank just one person for the change in their lives, though, it would be Joyce Powell, a case manager with the Care Management Program. Powell, an advanced nurse practitioner, keeps track of Ilene’s health conditions and has been instrumental in managing conflicts between the nine medications Ilene must take each day. Powell also communicates with Ilene’s many providers and makes recommendations to treat the constant pain resulting from her spinal stenosis.

Carey and Ilene Lindsey have been married for 46 years. Thanks to the Indigent Patient Care Program, he says they now have a shot at celebrating their 50th anniversary.

"You have no idea what it’s like to fight so hard and worry so much and then find out, all of a sudden, that this program exists," he says. "I’ve been meaning to write to Governor Vilsack to tell him about our experience here. I want to see the people who are holding this project together get some recognition for it."