Affording Medicaid: Many low income families pay for coverage

CAPE GIRARDEAU, MO (KFVS) - Individuals and families across Missouri are living below the poverty level just to qualify for Medicaid.

"How do they expect people to live on $762 and function?" Lisa Thomas asked me earlier this week as we sat down to talk about her situation, and her frustrations.

Thomas, of Cape Girardeau, wants to know why she and others much sacrifice so much, just to get the medical help they need.

"This is once a day, along with this one, yup once a day," Lisa Thomas says as she shows me the bagful of prescription pills she takes each day to combat her lung condition, arthritis, migraines, and a sleep disorder.

"In order to be able to try and keep myself able to move, I have to spend X amount of dollars," she said.

Thomas lives on a monthly $1100.00 disability check, which means she brings in too much money to qualify for Medicaid. In order for it to kick in, she has to bring her income down below the federal poverty level.

"The state of Missouri wants you to live on, like $762.00", she explains. "So anything above and beyond that, I have to give to them."

In Thomas' case, that roughly $300 difference is considered her spend down. She can send that amount directly to the state to qualify for Medicaid, or she can spend it on her medical expenses and turn in her receipts. But Thomas says she can't afford to do that, and pay all her bills. So most months, she says she has to get creative in order to survive.

"Borrowing money when I have to, going to churches for one-time help," said Thomas. "I've reached out to a lot of people. And it's just not me. It's more than just me."

"Well, there are a lot of people who do have a spend down," says Ruth Dockins with the SEMO Area Agency on Aging. Dockins tells me they advise their clients to have a monthly medical plan if their goal is to reach that spend down amount.

"Try to make your doctor's appointments and all of your medical expenses, pick up your medicines and things like that, the first part of the month," Dockins advises.

She also reminds clients they don't have to pay the spend down every month if they don't think they'll need the coverage.

"There's not really any point in them sending in $300 if maybe they're not even going to go to the doctor that month", she points out.

And, as Lisa Thomas found out last spring, there are other programs out there to help with medical expenses.

She qualified for the financial assistance program at Southeast Health, which wrote off nearly $24 million in medical bills last year.

"And that benefited over 5100 patients," Financial Services Director Kent Johnson tells me. "We have seen a big need and it continues to grow."

Johnson and his staff also help patients like Thomas prove they've met that Medicaid spend down when needed.

"We will actually send the patient's itemized statements to their local Department of Family Services," Johnson said.

Thomas tells me she appreciates that kind of help. But, she still questions a program she feels forces her to live on less.

"Even if I was working, I wouldn't be paying $300 a month in insurance. And if I was working, my income would be doubled", she points out.

Individuals can apply for Southeast Health's Financial Assistance Program. If a person qualifies, the benefits last for one year and includes 25-100% bill forgiveness for costs incurred at a Southeast Health facility or an associated physician based on income level and other factors.

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