Navigating the Medicaid Gap: Penelope

When Penelope Wingard was laid off from her job at a nonprofit after-school center in 2012, it was a major setback. Although her employer did not provide health benefits, her earnings had allowed her to sustain herself financially. As she began the daunting task of searching for a new job, she had no idea that a sudden diagnosis would derail her way of life.

In March 2013, Penelope went to the emergency room because of a pain in her side.  Despite having had a normal test result from a mammogram exam four months earlier, a CT body scan detected a mass in her breast. The next step was a biopsy.

Because she had no health coverage, personnel at the Levine Cancer Institute contacted the Mecklenburg County Health Department to help Penelope obtain Breast and Cervical Cancer Medicaid (BCCM) coverage.  To qualify for Breast and Cervical Cancer Medicaid, a patient must be referred to the health department or a state healthcare provider before cancer is ever diagnosed.

Without that referral, Penelope could not qualify for Medicaid and would not have been able to receive the treatment she needed.  She now realizes that the foresight of her physician at Penelope_Medicaid_Gap_070516_017Levine and that phone call saved her life.

Penelope began chemotherapy in June. While in the midst of cancer treatments, she suffered a brain aneurysm that required surgery and further complicated her health problems. She completed radiation and chemo treatments in February 2014 and shortly thereafter, Penelope lost her Medicaid coverage.

“As soon as I completed the radiation, my Medicaid was cut,” she said.

Though she was done with treatment, Penelope was not out of the woods. She continued to suffer complications from her breast surgery and resorted to emergency room services for pain relief.

With assistance from a supervisor, Penelope reapplied for Medicaid to continue treatment, but her application was denied.

The following January, Penelope needed a second brain surgery.  She was able to qualify for a grant that covered the cost of the surgery, but not the anesthesia. By November, Penelope had accrued $700 in medical bills that she was unable to pay. Her healthcare provider refused to continue treating her because of her balance, despite her serious health problems.

When she lost her vision in her left eye, Penelope called Physicians Reach Out, a program of volunteers from the medical community, where she was able to visit an eye doctor and then a specialist. In June, Penelope received a corneal transplant with financial assistance from the NC Center for the Blind.Penelope_Medicaid_Gap_070516_002

Her coverage for this care will end in August, but Penelope will need prescription eye drops for the rest of her life. Each refill costs $140. She has an appointment with a new oncologist to do post-treatment blood work. She is trying to get on with her life, but her medical bills continue to mount.

Penelope has tried to stay positive and put her life back together after overcoming the trauma of serious illness, but the struggle to piece together the health care she needs is overwhelming.

“The health care system in North Carolina is sad,” she said with tears welling in her eyes. “[Without LSSP] you don’t have anyone to stand up for you.”

However, Penelope has not given up. She is working with a health insurance navigator at LSSP to learn what her options are to receive coverage, including reapplying for Medicaid and seeking tax credit eligibility options in the Healthcare Insurance Marketplace.

Madison Hardee, senior attorney for healthcare access at LSSP, says that the healthcare system in North Carolina is incredibly complicated, and Penelope is like so many people across the state who don’t know that there are ways to qualify for healthcare coverage without an income.

“She was lost in the system and told that she wasn’t eligible for anything,” Hardee said. “With the help of a navigator, Penelope now clearly understands the eligibility rules for Medicaid in North Carolina and the Healthcare Insurance Marketplace.”

Penelope also urges other women to seek care even if they are afraid of the treatment and costs that may result from an exam.

“Tell women to do the treatments, and pray things get better,” she said.

Penelope_Medicaid_Gap_070516_023Penelope is one of 300,000 people in North Carolina who fall into the Medicaid coverage gap. She is ineligible for Medicaid because she has no children or qualifying disabilities, and she earns too little to qualify for tax credits that would help her afford insurance through the Health Insurance Marketplace.

If North Carolina’s General Assembly expanded its Medicaid program in our state, Penelope could access the health care she needs. Without it, Penelope and so many citizens remain stuck in the gap, navigating a confusing healthcare system and waiting for change.

 

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