New York's Facilitated Enrollment Program was originally conceived as an interim solution to the complex enrollment requirements and procedures of state-subsidized programs. Now in its fifth year, the program, which enlists the help of volunteers based at nearly 50 community-based organizations, works with low-income families to navigate the confusing maze of rules and processes. The enrollers explain requirements to clients, help them locate documentation and fill out applications, and follow up with the Medicaid office and insurers. A Fund-sponsored study of enrollers documented the need for continuing this program.⁽²⁸⁾

Connecting New Yorkers to sources of care, regardless of their health insurance status, is another key component of the Health Care in New York City Program. In the spring of 2004, Thomas Frieden, M.D., commissioner of the city's Department of Health and Mental Hygiene, launched "Take Care New York," a campaign to achieve 10 health improvement goals—among them ensuring that every resident has a regular health care provider. The Department estimates that 1.4 million New Yorkers do not have a personal doctor, along with the benefits associated with continuous, coordinated care.⁽²⁹⁾

Concurrently, the Fund's program has expanded its scope to include improving linkages to primary care. A new project is helping to connect schoolchildren and their families with insurance and health care providers in disadvantaged neighborhoods, starting with elementary schools in Manhattan's East Harlem and the East New York/Bushwick section of Brooklyn. With Fund support, school nurses are working with the city health department, the Mayor's office, and local providers to identify and refer children in need to health care and coverage.

A second project focused on primary care access is testing a handheld computer called "Asthma Buddy," which is designed to help children monitor their asthma and communicate with nurses and doctors at hospitals. In a pilot study, the intervention significantly reduced hospital and emergency department (ED) admissions. The Fund is now supporting an evaluation to see if the improvements can be replicated in five hospitals across the city.⁽³⁰⁾

Building on previous Fund-supported work conducted by John Billings of New York University,⁽³¹⁾ a new initiative is testing innovative strategies to improve access to primary care and reduce ED use for nonemergency care. Billings' analysis has demonstrated that over three-quarters of ED visits in the city were for care that could have been provided in primary care settings. In launching this project, the Fund seeks to identify and evaluate innovations that connect ED users—many of whom are uninsured and low-income—with a regular source of primary care that is both acceptable and convenient.