Not anymore.

With just months remaining in what was a three-year pilot project, the organization is preparing to transform itself into something that looks a lot like an insurance plan, one aimed at providing a relatively cheaper insurance option to small businesses with low-income workers.

Individuals could still get coverage, but at a cost. And Project Care would like the state to match that premium, perhaps through an expansion of Medicaid.

WADE SPEES/STAFF Catherine Ferry Middleton is executive director of Tri-County Project Care. The nonprofit, which provides free health care coverage to low-income people, plans to offer low-cost health insurance to small businesses.

The agency has hired Catherine Ferry Middleton, the former chief executive of Cigna Healthcare's South Carolina operations, to help do the job.

To Project Care, charging premiums and getting state help is the only way to put a dent in the growing number of people without health insurance. Thus far, the agency has relied on donations from doctors, hospitals and other organizations to provide free care to more than 2,000 residents -- a fraction of the estimated 100,000 Charleston area residents without coverage.

"If it costs $2,000 a year for that patient population, that's $200 million" to cover all of those 100,000 people, said Dr. Casey Fitts, the Charleston surgeon who founded the organization. "There is no ability to get those kind of donations."

The agency is still in the process of forming its plan. Its efforts depend on the work of the Commission on Health Care Access, a committee formed by the General Assembly this year to come up with a plan to help small businesses provide health insurance for workers.

The commission was given three main responsibilities: craft legislation to allow programs like Project Care to collect premiums, or "prepayments," for its services; develop a Medicaid-expansion program that would subsidize the premium for low-income workers of small businesses; and educate residents to be better health care consumers.

The issue is an increasingly important one. The number of uninsured nationwide grew to 45 million last year. In South Carolina, 13.4 percent of the population, or nearly 550,000 people, went without coverage in 2003.

At any point during that year, nearly one of every five state residents didn't have health coverage, according to a study by the state Department of Insurance.

Much of the problem is due to rising health care costs. Small employers, with fewer workers and less negotiating power with insurers, have been hit hardest, and many have dropped coverage because they can no longer afford it.

"It's a very significant problem and it's going in the wrong direction," said Bob Toomey, former director of the state pension system and current chair of the commission.Fitts took a year off from his surgery practice to found Project Care in 2001. The organization is funded by contributions from area hospitals plus a three-year, $7.5 million grant from the Medical Society of South Carolina.

The program's network includes 1,600 doctors, or 80 percent of area physicians. It has more than 2,000 members and has provided more than $7.9 million in services, including 14,591 doctor visits. Its coverage is comprehensive: It has paid for everything from routine doctor visits to a heart bypass.

Fitts' goal was to show that the health care system could save money by getting the uninsured into the doctor's office early, getting at health problems before they become severe and reducing costly emergency room visits that often go unpaid.

According to the nonprofit, that plan has worked. The longer a person is in Project Care, the less it costs per month to treat them. On average, an enrollee's per-month cost drops from more than $350 a month to less than $50. Perhaps most importantly, people in the program tend to visit emergency rooms less frequently.

But the agency's three-year experiment ends in January, and Project Care needs a way to survive over the long haul and cover more people.

It is counting on the legislation that would authorize prepayments to do that. Fitts said Project Care has enough money to keep operating until that proposal is passed.

In the meantime, the agency is preparing for the change. In April, for instance, it brought in Middleton as its new executive director. "Our organization has taken a quantum leap forward by having her expertise on board," Fitts said.

Middleton said Project Care plans to survey businesses to gauge their health insurance needs. It also is working on a financial plan. "We've learned from the pilot project that this does work financially. It's just a matter of putting it together in a package," she said.

The plan would sell coverage to small employers to cover their low-income workers. The legislation would likely limit the agency's charge per worker to less than $1,000 a year -- a third of the typical health insurance premium for an individual, according to the Kaiser Family Foundation, a California nonprofit that researches health care issues.

Both the employer and the worker would contribute to the premium, Fitts said. Individuals could get insurance, too, but would have to pay the cost themselves.

To boost this effort, Fitts would like to see state funds chipped in that would match the premium charged by programs like his. Those funds, he said, could then be rolled into a Medicaid program, which would draw down federal dollars -- reducing the cost for the state, and allowing the agency to help more people.

He believes the government funds are vital to enable agencies such as his to cover more people.

"That's a key component," Fitts said. "If you don't have governmental funding, you start backpedaling. Your impact will be lessened."

Fitts said Project Care would not compete with commercial insurers. Instead, it would likely work with them, perhaps requiring that a business buy commercial coverage for middle-income workers and the less expensive coverage from Project Care for those who make less.

To keep employers from ditching their current coverage for cheaper insurance from Project Care, Fitts said, the plan would be restricted to companies that haven't provided coverage for at least a year.