“It’s been kind of weird because it seems like the eligibility changes a lot,” Eddie, 26, told me, referring to his girlfriend’s eligibility for Medicaid. “Because she’ll have it, and then one day she’ll get a letter in the mail saying it’s canceled. And she’ll ask people and nobody seems to know why… You leave messages and nobody ever calls back.”
Eddie’s girlfriend, Ashley, is unemployed and a recovering drug addict. As I noted in my last piece, she has depended on Medicaid to help cover the costs of addiction treatments. But at the time of our interview, she was re-applying after inexplicably losing it.
“Right now, if she ended up in the hospital, she’d have this huge doctor bill,” Eddie said.
They’re not alone.
The first time Adeleigh, 26, applied for Medicaid for her expectant child, she was “22, unmarried, single, pregnant with this kid, and I was like, ‘Okay, insurance.’” Working a part-time, minimum-wage job, she figured her daughter would definitely be eligible. But before the birth of her daughter, she was denied five times.
Why? “They said I didn’t qualify for whatever reason,” she said, “even though I wasn’t working at the time and when I had left my job I was making significantly under the poverty line.”
Her newborn daughter spent almost a week in the neonatal intensive care unit and amassed an almost $25,000 medical bill before a woman in the hospital’s financial assistance office stepped in and called the county to chew them out. “You have no reason to deny these people insurance!” she lectured them. “What are they supposed to do? They don’t have anything to pay for this.”
Adeleigh’s daughter received Medicaid after that conversation. As Adeleigh said, the hospital staff “fortunately was able to push the right buttons.”
A few years later, Adeleigh was in a predicament. A diabetic, she now had Medicaid for herself and her daughter. She planned to marry her fiancé, Josh, but she learned that it might mean losing Medicaid. She could receive health insurance through her employer, but that plan would require her to cover the costs of her diabetic supplies. The math was simple: she made a little more than $18,000 a year, and her diabetic supplies alone cost about $18,000. Bottom line: she couldn’t afford to lose Medicaid.
So she called the county office again. “Can I set aside a time to sit down with somebody and discuss this?” she inquired.
“You can’t really do that,” the clerk replied. “There’s not a formal process with this.”
“You’re kidding me,” an incredulous Adeleigh said. “You can’t just make an appointment and come into the county and bring files and go, ‘Okay, what are we looking at here? How does [getting married] impact us?’”
Adeleigh recalls talking to two or three people, all of whom said “no.” She had to basically figure it out on her own. She looked online, but she described the website of the Ohio Department of Jobs and Family Services as “insane” and navigating it “kind of tricky.” She recalls eventually finding “a general guideline” that suggested that if their combined income was under $25,000, they would be eligible. Because they earned more than this annually, marrying would mean they would lose her and her daughter’s Medicaid. (Today, the Ohio Medicaid website says that the income threshold for an adult in a household of four people is about $32,000 a year.)
Still, she just wanted to talk to a real person and get some clarification and guidance. After all, what if she was looking at an outdated chart? What if there were exceptions of which she was unaware? What if she would eventually have to report their combined income anyway? (The answer to the latter question is “no”: only cohabiting couples with a biologically-related child must report their combined income. Since Josh is not the biological father of Adeleigh’s daughter, they need not report their combined income while cohabiting.)
“It seems like whenever I reached out to an actual human being, it was tremendously unhelpful,” Adeleigh said.
She doesn’t believe it’s right, “but I get why people abuse the system,” she admitted. “Because, well, no kidding, if they’re not going to be helpful, I can’t fault you.” As she sees it, confusion begets abuse and long-term dependency.
Eddie’s story points to something similar. The possibility of suddenly getting yanked off Medicaid has contributed to his girlfriend’s hesitancy about getting married.
“If you were talking to a legislator in Washington, DC, or Columbus, Ohio,” I asked him, “what do you think could be done to help?”
“I’d probably say clear-cut guidelines, and then maybe more transparency,” he said, adding:
Instead of one day, it’s just gone, at least send you a notice beforehand saying ‘Hey, this is an issue. Let us know what’s going on.’ That way at least you know, okay, it’s going to end and I can make some other arrangements. Not get a letter in the mail and it’s already been canceled. At the same time, if you’re on it and then you become ineligible, I feel like they should be required to maybe put you on another plan even if it costs you money. Like, you can cancel here, but this is a plan that you can get and this is how it much costs… Instead of you go from something to nothing; you go from something to something in between.
Ashleigh’s complaints about the lack of “guidance” she encountered, and Eddie’s desire for “clear-cut guidelines” got me thinking about Paul Ryan’s 2014 proposal to match people receiving benefits with one case manager who could help individuals navigate a confusing system. As Ryan had said about his plan, “you could go to one office and you go to work with one person for all of your needs. That person would give you financial assistance and would also act as a personal resource.”
If Eddie did have this kind of case manager assigned to him, would he be interested?
Oh, yeah, definitely. I would like to be able to…[meet with] somebody that would be able to point me in the right direction. Things I could be doing [and] should be doing. And what’s available, what isn’t. What I’m eligible for, what I’m not. Because now you go there, and you sign up. Either you are or you aren’t. They never tell you why. And then it doesn’t make sense how you’re eligible for some things and then not others… Like I said, guidelines. It would just be nice to know, ‘Okay, this is the guideline I don’t meet, now I understand why I’m not eligible. I get it.’ And if they kept doing that…more people would be able to understand what’s going on.
Ohio governor, John Kasich, also agrees with him. In his 2015 budget, Gov. Kasich outlined a plan that would “tear down the silos” in the welfare system and give each Ohioan receiving public assistance one caseworker who would connect them with the assistance they need, as well as job training efforts.
“In our social service delivery system, there is no coordination," Kasich lamented. “Here I get my food stamps. Here I get my child care. Here I get this. Here I get that. And I spend most of my time standing in line and not being treated.”
Ohio recently implemented this approach with young Ohioans ages 16-24 who receive TANF or job training services, but Kasich eventually hopes to expand it to all Ohioans on public assistance.
A “one-stop shop” case manager who can show you around—and the way out—would help those of us receiving benefits.
It’s a promising idea. Some people might think that letting welfare remain chaotic makes it less attractive to recipients, and therefore makes them more likely to leave. Actually, it sows confusion and uncertainty about what’s going to happen if you marry or take more work. The incentive is to avoid risk: avoid getting the extra hours of work, or avoid getting married. Because what if I lose the child care that I can’t afford on my own—and therefore can’t work? What if I lose my health insurance? In many cases, it seems to me, the risk avoidance is actually a form of planning and prudence, and looking out for your family.
Public assistance programs can be confusing. But a “one-stop shop” case manager who can show you around—and the way out—would help those of us receiving benefits.
For instance, when I poked around for lead-paint removal grant programs—our fixer-upper home includes a pregnant woman, two kids under five, and chipping lead paint—I called the county health department, but the kind person who answered the phone said she knew of no such program. Later, during a pregnancy check-up, Amber asked a social worker if she knew of any grants. Within minutes, she emailed us six links, including one to a grant program for low-income Ohioans with children who have lead-paint hazards in their homes.
To create a welfare system that empowers people to find the help they need and to eventually achieve self-sufficiency, we need solid facts and personal guidance. (We also need living-wage work and affordable health insurance—issues I addressed in another post.)
And to make welfare better, we should make it small and personal—more like a visit to your personal financial planner, and less like the DMV. That’s the kind of personal care that can truly empower people to achieve self-sufficiency.