How We Accidentally Enrolled in Medicaid and Faced Financial Ruin

Medicaid by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

I should start with some background.

Without going into too much detail, 2017 and 2018 were both incredibly bad years for my family. In fact they were two of the worst years of my life. The biggest event is that my wife Clancy had some health problems and had to take leave from her job. Due to a cut in state funding, her employer eliminated the service that she worked on meaning that there was no job to go back to. That didn’t actually matter that much, though, because her condition worsened and much of 2017 was spent seeing specialists outside of the area. Her health did start to improve, but she was not ready for travelling work and under a geographically expansive non-compete. The non-compete ended in the summer of 2018 but by that point she had a dreaded Gap In Her Resume that would limit her options. Then she was served with a lawsuit, which further cast a cloud over her employment prospects. Also there was a miscarriage.

One of the important aspects of all of this was our unwarranted optimism that things would get better in short order. One of the main reasons I didn’t spend too much time looking for work was because it didn’t seem worthwhile given that my earning power was a fraction of hers and her recovery was, we were sure, right around the corner. If we’d known how long things would be bad we likely would have taken much more dramatic steps such as selling our house and relocating to hunker down with family in a trailer her parents own. Something like that. Clancy’s life was not in imminent danger, but her ability to ever go to work was in uncertain. For good reasons (calculated risk) and bad (denial), we didn’t spend that much time contemplating what would happen if she wasn’t able to return to work. And at almost every phase there was reason to believe things could improve.

As all of this was happening, our daughter Lain was having problems with her eyes. Most specifically she had a “lazy eye”. From the time she was two or three that was just something to keep an eye on and not worry about it until very suddenly her ophthalmologist was very worried about it. The ophthalmologist saw something that really rattled him and immediately put us in touch with a pediatric surgeon. After further evaluation and consultation, surgery was scheduled on January 7, 2019. That date would become important.

In November of 2018, it was time to sign up for insurance through the marketplace as we had done in previous years. During that process, they ask a question whether I wanted to investigate premium assistance. In 2017 I had said no; since recovery was Right Around The Corner we wouldn’t need it. In 2018, I was still skeptical about taking it but I thought at least it wouldn’t hurt to find out.

Shortly after that, I would determined I had made a terrible mistake.

Having no income, we were eligible for Medicaid and automatically enrolled. Having enrolled in Medicaid, we were no longer eligible for Marketplace plans. Our plan would expire on January 1 at the latest, with no option to renew. Our Healthcare-dot-gov account was essentially locked down. I went down to the state health department office to try to get this straightened out. It took hours talking to multiple people (none of whom had ever had someone come in and asked to be dropped from Medicaid). They determined that they could drop us, but since it was voluntary we still likely wouldn’t be eligible for the Marketplace. There was no mechanism by which they would inform the federal government that I wasn’t on Medicaid and as far as the federal government was concerned I was. They said to call Healthcare-dot-gov customer support, which I did, and after much discussion they determined that it was Medicaid or nothing.

Being on Medicaid had a number of advantages. First and foremost is that we suddenly had $1500 in our pocket per month. We were also saving money on copays. We also didn’t have to worry about copays, which is a separate delight. The level of Medicaid we were on either paid for something or it didn’t, and Medicaid would pay for things that private insurance wouldn’t (like out of state emergency room visits). There were, however, at least two major downsides: Wait times to see a specialist were a mile long, and absolutely nobody out-of-state was in network¹

To tell you a little about where we live, we are at the intersection of our state and two others. In addition to the US capital, we are closer to five state capitals than we are our own. The nearest town as a few ten thousand people, but it has a lackluster economy and therefore comparatively few services. My daughter’s school at the time was in West Virginia, but the next one was out of state and the one after that was in a third state. Almost everything we do outside of our county, we do out of state. I will confess my view of federalism is not as positive as it once was.

This presented something of a problem, because the January 7 surgery was scheduled with a doctor in Maryland. Further, the nearest pediatric eye surgeon in West Virginia was three hours away in Morgantown. Also, because doctor’s orders and recommendations from doctors out of state were invalid, we would have to start much of the process all over again. The first opening for a consultation was in nine months. That meant another year that our daughter’s vision would be severely hindered.

In addition to all of this, our bank account was dwindling fast due to lack of income and general spending at a level that assumed that recovery was Right Around the Corner. Unaware of how bad our finances would eventually get, we really didn’t think we could afford $18,000 out of pocket for surgery. But we also couldn’t wait another year for surgery.

All of this made more maddening by the fact that by February (the “around-the-corner” date at the time), we would so obviously be back on our feet and kicked off Medicaid. The duration of Medicaid would manage to be just long enough to screw us up on the surgery. We had even thought of postponing the surgery until March on that basis. Fortunately, there was a little voice in the back of my head that pointed out there was a possibility that might not happen just as it hadn’t happened the previous six times improvement was Right Around The Corner.

In the end, she got the surgery. The surgeon marked down the price considerably and we got a loan from my parents. Our fortune and privilege there is not lost on me, I assure you.

“Around the corner” did finally come in late summer of 2019, when she got her first Real Hospitalist gig out in Idaho. Then some work in Minnesota. Then something more durable with the Indian Health Service, where she has worked ever since flying back and forth to New Mexico. Clancy was dropped from the lawsuit after in a deposition the plaintiff had said that she was pleased with my wife’s service. Because of the way Medicaid works, we were on the rolls until Spring of 2020. By that time it had indeed saved the family money and we are grateful it was there². We’re also glad to be off of it, because that means that we are back on our feet and we can see our regular out-of-state doctors again without paying out of pocket.

Lain’s surgery was difficult for her, but after she recovered she reported that she liked it better that there was no longer two of everything.

1. Actually, there was a third category besides “paid or didn’t” that was also the third downside: If Medicaid didn’t cover a medication, and you were on Medicaid, then if the pharmacist knew you were on Medicaid you could not get that medication even if you were willing to pay cash. This applied both to certain types of medication but also to prescriptions: If an out-of-state doctor gave you a prescription, Medicaid wouldn’t cover it and the pharmacist couldn’t fill it. The easiest way around this was simply to go to another pharmacy, but it was indicative of some of the ways the state seemed to go out of its way to make things inconvenient.
2. West Virginia was a Medicaid-expansion state at that point. Given that, I was surprised at how little you had to make to get kicked off the rolls.