The state legislature has given final approval to the Island Health Plan to make use of millions of dollars in state subsidies for the grassroots health insurance initiative.

After more than a year of inching toward legislative approval, this week's senate override vote gives the needed clearance to begin offering low-rate insurance to Islanders without it.

More than four years in the making, the Island Health Plan is designed to offer insurance to the Vineyard's estimated 3,000 uninsured residents.

"It's been a long struggle, but it's finally happening," said Cape and Islands Senator Robert O'Leary yesterday.

Wednesday afternoon, the Senate voted to override the governor's December veto of the legislation. The House already signed off on the measure earlier this month.

By banding together the staff of many of the Island's small businesses and self-employed residents, the Island Health Plan leverages their buying power to link with a private insurer. The state subsidies - which will deliver about $2 million to the pockets of Islanders - make affordable this market-rate insurance plan.

This step was a long time coming, but provided a necessary piece of the logistical puzzle.

"The Cape and Islands delegation was attentive throughout, and it was a long haul," said Cynthia Mitchell, director of the Island Health Plan. "Ultimately, it became a leadership question. The senate and the house both signed off on it before, so it wasn't a matter of trying to garner support from legislators. It was a matter of keeping it in front of the leadership."

The Island Health Plan will be marketed to small employers next month. Aggressive enrollment will begin in September, Mrs. Mitchell said.

The legislation allows the Vineyard, on an experimental basis, to extend this health insurance plan to Islanders earning less than 400 per cent of federal poverty level. Those earning less than 300 per cent of federal poverty level, $55,000 for a family of four, and their employees can receive subsidies through the state's Insurance Partnership program - a public-private initiative which offers funds to employers providing private insurance for their employees.

As a final step, the state Division of Medical Assistance (DMA) must also give its blessing to raising the income threshold for eligible Islanders. Mrs. Mitchell said that officials from this agency were enthusiastic about the experiment when the Island Health Plan initially filed the legislation in December of 2002. Gov. Mitt Romney has since reorganized the DMA, however, and Mrs. Mitchell said she hopes for another positive reception.

"Now, we're at a point in which that can legally happen. You deal with one thing at a time. The next challenge will be securing a physician base," said Senator O'Leary.

The Island Health Plan, which is contracting with Boston-based health maintenance organization Neighborhood Health Plan, is well on its way to enlisting Vineyard physicians. At least five primary care physicians have signed contracts with Neighborhood Health Plan already, Mrs. Mitchell said.

"We have enough signed on to handle the capacity," Mrs. Mitchell said. "We'd love, of course, to have every Island physician as part of the network, but it's not necessary. We hope to work up to that."

A few primary care doctors declined participation, she said, because they have a closed practice, not because they did not want to be involved in the Island Health Plan program.

Neighborhood Health Plan is still negotiating a contract with the leaders of the Martha's Vineyard Hospital. Mrs. Mitchell said that hospital leaders wanted to see the legislation finally approved before signing off on the contract. She expressed confidence that Island Health Plan will have a formal relationship with the hospital, but the parameters of that have not yet been fully defined.

"It's unclear what services NHP will contract with the hospital. Certainly, inpatient and emergency room services will be included," said Mrs. Mitchell.

Attempts to reach hospital chief executive officer Timothy Walsh at a conference yesterday were unsuccessful.

Beacon Health Strategies, the mental health component of the Island Health Plan, is negotiating a contract with Martha's Vineyard Community Services for mental health services. Community Services' Island Counseling Center is also currently undergoing credentialing with the private insurer, Mrs. Mitchell said.

The Rural Health Clinic, which will fill the role of one of the primary care physicians offering services to IHP enrollees, is set to open in the coming weeks, Mrs. Mitchell said.

Last summer, the Island Health Plan, along with the Vineyard Health Care Access Program and Vineyard Nursing Association, secured a $500,000 federal grant to open a rural health clinic on the Island. The first of its kind in the state, the clinic will be able to tap into cost-based reimbursements for users of state and federally subsidized insurance. These reimbursements are expected to sustain the clinic in the years to come.

Mrs. Mitchell said they have hired staff for the clinic and are simply awaiting a license to operate from the state Department of Public Health.