The Affordable Care Act and New Jersey's recently expanded Medicaid program were designed to increase health-insurance coverage for those who lacked it or could not afford it.

But some segments of the population still lack it and still cannot afford it, said Jacqueline Meiluta, executive director of Volunteers in Medicine of Cape May County.

The free, safety-net general care practice continues to see a steady stream of patients little altered by the Affordable Care Act.

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Patients may earn too much for New Jersey Family Care, the state Medicaid for the lowest-income residents, she said. And those who can pay ACA-subsidized premiums for the cheapest plans often cannot afford $2,500 deductibles.

"These are the people we've always treated - our commercial fishermen, chambermaids, waitresses, bartenders, landscapers," said Meiluta, of Sea Isle City. "Cape May County is a service economy, and those are the types of jobs that don't offer health insurance."

The sweeping changes to health-care reform in the U.S. have raised questions of the roles that organizations like donation-funded Volunteers in Medicine will play in this new landscape.

But there remain cracks in the system, said Dr. Elizabeth Crowley, the medical director at Cape May County's Volunteers in Medicine.

Even some who qualified for Medicaid are struggling to find primary-care doctors that accept it, she said.

The National Association of Free & Charitable Clinics, a Washington, D.C.-based nonprofit, says patient demand at such clinics rose 40 to 50 percent in the past two years, while donations dropped 20 percent.

In Cape May County, Volunteers In Medicine, a 12-year-old practice of volunteer doctors and nurses located on Route 9 in Cape May Court House, has about 500 patients who log about 3,500 visits per year. Meiluta estimated about a dozen patients applied for the ACA's higher-deductible bronze plan, and about another 60 qualified for Medicaid.

The practice accepts county residents who earn no more than 300 percent of federal poverty guidelines, or a maximum of $59,370 for a family of three.

The organization previously prohibited services to those with no access to insurance. In January, the policy was changed to accept qualifying patients who have insurance deductibles of at least $2,500, she said.

In Southern Ocean County, Coastal Volunteers in Medicine opened in Stafford Township last April and moved recently to a location on South Main Street in Barnegat Township.

It has about 250 established patients and has a growing waiting list of about 45 people, said Maria Hennessy, practice administrator.

"We feel it's too early to tell whether all of our patients are going to be able to afford one of those new health care plans in the new market place or whether they will be absorbed into Medicaid," Hennessy said.

She echoed concerns about patients who qualified for Medicaid but will have trouble finding doctors to accept them.

Coastal Volunteers in Medicine has a slightly different threshold for qualified patients than Cape May County's. The Barnegat office accepts those living in an 11-zip code area in southern Ocean County and whose family is below 250 percent of the federal poverty level, or $49,475 for a family of three.

Also, patients cannot have insurance.

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