Fox said that while he remains opposed to using county tax dollars to fund initiatives like health coaching, which is one of the plan's components, he is less critical of the Door because of its emphasis on connecting residents with existing programs.

Filling gaps

One such connection was made on a Wednesday morning this spring for Belen Fernan, 63, who moved with her husband from Cebu City in the Philippines to her daughter's home in Long Reach in June 2010. Three months later, while looking for jobs, her husband had a heart attack and died, leaving Fernan shaken and even more concerned about her own lack of health coverage, she said.

"We are old already," she said. "Anytime, we can get sick."

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Though she said she was embarrassed asking for help from a government agency, Fernan met directly with Wendy Flores, a client assistant with the Door, to fill out an electronic application. As Fernan is just below retirement age and a permanent resident but not a citizen, her case was a difficult one. The application results showed she wasn't eligible for any state programs, only for Healthy Howard's plan, which Flores told Fernan would likely cost $50 a month. Fernan said she couldn't afford that, but agreed to have a meeting with Healthy Howard staffers the following week.

When the meeting took place, Hershkovitz said, the cost was still prohibitive for Fernan. But staffers suggested she apply instead for the Kaiser Permanente Bridge Program, which provides coverage to people in situations similar to Fernan's starting at $20 a month. Fernan is now enrolled in the program.

Moving forward, Healthy Howard Executive Director Liddy Garcia-Bunuel said the Door will increasingly become the organization's most active program, serving not only low-income residents eligible to enroll in state or federal health programs but also middle-class residents looking to enroll in federal health-care exchanges in 2014.

Shifting gears

That growth will come just as Healthy Howard's signature health plan becomes obsolete, Garcia-Bunuel said. Because it is not health insurance and would not meet the new federal requirement, Healthy Howard intends to discontinue the plan starting in the summer of 2013, with an emphasis on transitioning clients into federal exchanges.

As the plan "shrinks away to nothing," and the Door becomes "very robust," Beilenson said, Healthy Howard will take a new, leaner form that will "clearly need less than the $500,000" per year in county funding to maintain.

Ulman said that having the Door in place has put the county "leaps and bounds over folks around the country" in terms of preparation for the federal reform. Still, he and Beilenson said they are concerned that the federal government has not done adequate preparation.

Federal officials are "tragically naive" about the law's roll-out, Beilenson said. They are full of "pie-in-the-sky thoughts," Ulman said, and think they'll be able to "wave a magic wand" to settle confusion among thousands of residents.

Beilenson said he expects there will be "a deluge of people, and possibly an ongoing one," who show up confused at his department's offices after being warned of the federal law by mail, making the Door an invaluable asset.

"There's got to be real, live people helping people with this system, and it's not going to happen at the state level. It's going to happen at the local level," he said.

In providing that help, the Door will remain a strong program, he said.

But it's not the only Healthy Howard program he and others hope will continue beyond 2014.

Another one is the health-coaching component of the health plan, which pairs clients with coaches who help them set health goals and assess risk factors in their lives. The program could be getting new wind in its sails in the run-up to 2014. It just won a national Healthy Living Innovation Award from the U.S. Department of Health and Human Services, and recently received a grant to study ways to monetize itself by attracting paying customers — whose fees would subsidize the coaching of nonpaying customers, Beilenson said.

Such funding could be necessary once the health plan itself is discontinued.

Fostering wellness

Also likely to continue beyond 2014, officials said, is Healthy Howard's "community wellness" program, which was transferred to the organization from the county Health Department in October 2010. The program identifies and rewards schools, businesses and restaurants for pursuing health-oriented programs or innovations, said Robin McClave, Healthy Howard's outreach and community partnerships manager.

Rather than preparing for a 2014 end date, McClave said she is now working on expanding the program to include faith communities, individual family homes and recreation communities.

"We've made our society very convenient for all the things we have to do, and unfortunately, health hasn't been on that list," McClave said. "We want to change people's thinking."

One success story that was recognized by Healthy Howard occurred at Hollifield Station Elementary School in 2008, when administrators there made the decision to hold recess before lunch, instead of after. The result was that more students completed their lunches, and were more alert and engaged in the afternoon, said Patti Caplan, a schools spokeswoman. Schools throughout the county are being encouraged to follow a similar recess schedule.

Overall, Garcia-Bunuel said she has given no thought to closing up shop at Healthy Howard, only to fine-tuning programs, attracting more outside funding, ramping up the Door, and finding the best way to transition clients out of the health plan and into federal exchanges when the time comes, she said.

Josh Curtis, the organization's young deputy director, who started at the organization as an intern and now serves as Garcia-Bunuel's right-hand man, echoed those thoughts.

"It's about addressing fundamental issues that are a barrier to your health," said Curtis, a 2008 graduate of University of Maryland, Baltimore County.