Kentucky Rushes to Remake Medicaid as Other States Prepare to Follow


He now works 20 hours a week, but he has neuropathy, a numbness and tingling in his hands and feet, and sometimes has trouble walking. Should he cut back his hours, he’d either have to try to get classified as “medically frail,” which would exempt him from the work rule, or lose his coverage.

He hasn’t thought all that through yet. In concept, though, he supports work requirements — as do most voters, polls have found.

“That’s not bad, to tell you the truth,” he said. “If you’re working, that’s good for your health.”

As he spoke, he gulped water from a bottle he kept refilling — his extreme thirst a sign of his health crisis. Kara Peers, a case worker at Family Health Centers, tried to gauge what other challenges he and his wife and four children might be facing that could interfere with his ability to manage his disease.

“What about food, sir?” she asked.

“Ah, we’re kind of low,” he replied.

“Utilities — are you able to pay the bill?”

“It can be tough.”

He left with a month’s worth of medications — three for diabetes, one for high blood pressure, paid for by the clinic — and the reassurance that his Medicaid would soon be reinstated. Melissa Mather, the communications director at Family Health Centers, said she worried that patients like him, who already stumble over Medicaid’s paperwork requirements, will be more lost under the new rules. She and Mr. Wagner are also worried about their homeless patients, who will be subject to the rules unless they meet the federal definition of “chronically homeless” and get an exemption.

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Mr. Coleman picking up his prescriptions from Family Health Centers in Louisville.

Credit
Aaron Borton for The New York Times

“This is a very, very big concern from my perspective — talking about the complexity of these changes when a lot of the folks we deal with have lives that are in chaos already,” she said.

For now, there are more questions than answers, as state workers like Ms. Putnam hustle to iron out all the details, let alone explain them. Like Mr. Carter, Sarah and Matt Burress got Medicaid under the Affordable Care Act after going uninsured for years. The coverage may have saved Mr. Burress’s eyesight — though only 29, he was diagnosed with advanced glaucoma when he went for a routine eye check shortly after becoming insured in 2015.

Now he’s worried about keeping his coverage because he runs his own small lawn care business, working irregular hours with a hiatus that lasts all winter.

“We haven’t heard how it will work for seasonal self-employed workers,” said Ms. Burress, who works part time as an office manager. “Do his clients have to say, ‘Yeah, he mowed my grass this week?’ Part of it feels like they’re trying to catch you, by burying people in paperwork and making it a huge inconvenience.”

She added that she and her husband plan to remain on Medicaid only until his business starts turning a profit. “This was never meant to be our permanent fix,” she said, not the “dead-end entitlement trap” that Mr. Bevin rails against.

Most people on Medicaid do work, research has found; Those who don’t often are disabled, even though they may not qualify for Social Security Disability Insurance. Sheila Penney, 54, has cycled in and out of jobs for years with chronic depression and anxiety that started when she lost her father at 16. She has worked as a package handler, a boat reservations manager and even a health insurance enrollment counselor, helping patients at Family Health Centers sign up for Medicaid back in 2014.

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