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Medicaid Slots

 Kandis

“Medicaid has definitely came in handy and been a relief all my life,” said Kandis, who is a recent ovarian cancer survivor. Kandis was unexpectedly diagnosed with ovarian cancer in November 2020, during the height of the COVID-19 pandemic. “I did learn from being sick like that and doing chemo it was very important to have Medicaid. It was definitely a blessing as far as when I got really really ill.” 

Kandis was found in her apartment unconscious and was rushed to the hospital. “I am blessed to be alive cause I was pronounced dead on November the 10th for like two hours. When they got me in the ambulance, they couldn’t get me to come back and resuscitate.”  Kandis was resuscitated and spent a month in the hospital where tests were run to figure out her diagnosis. The doctors eventually found out what was causing her sickness. They diagnosed her with ovarian cancer, and she was able to receive treatment to remove the mass. “I actually feel better than I’ve ever felt in my entire life. There was definitely a problem with my health, and I didn’t even know it.” After receiving chemotherapy, Kandis also went through physical therapy to help her regain her strength and learn how to walk again. Her treatment was all covered by Medicaid insurance.  “It’s important for you to get your health taken care of. The way I used to feel and got used to feeling that was probably what was wrong with me all that time. I didn’t take care of myself like I was supposed to and now that I have, I feel a whole lot better.” 

Kandis is now able to live her life again and help give back to others in her community. She volunteers at a local women’s center where she focuses her time on other women who have shared similar life experiences.

 “The negative is the meds, not being able to get all my medications cause I don’t have enough slots on Medicaid.”

Medicaid allows each beneficiary 6 medication slots to be filled each month. If the number of medications needed is above the allotted slots, the person must pay out of pocket. “They need to change how they do medicine and prescriptions and set it on a person’s conditions not just set on everyone having the same thing. Some people’s conditions are worse and some people have way more prescriptions to get filled than others. Like me, I do, I have to pay extra every month for my prescriptions. It’s hard. I can’t even get stuff for my household because I am taking all the money I do raise.. and it put it towards my medicine and stuff.”  Kandis is paying around 300 dollars each month out of pocket for her prescriptions, medicine she can’t physically afford to live without. The money that she is putting towards her prescriptions causes her to neglect other critical areas in her life since she is still in recovery. Kandis hopes to regain her full physical strength so that she can rejoin the workforce. “I want to build my strength back up to be who I used to be and be stable enough and strong enough to take care of myself.”


 Devora

Devora explained that having Medicaid coverage has been mostly positive. In the 19 years that she’s been a Medicaid recipient, she has never been denied any medical treatments. “The medication benefits are good and I don’t pay anything to see the doctor or go to the hospital. I didn’t have to pay anything to get this chair.” This is extremely important since Devora has limited income.

“Medicaid and Medicare keep me from having extra expenses.”

In 2007, Devora experienced a near-death medical experience due to problems with her lungs. Luckily, she was a Medicaid recipient and was able to receive life-saving treatment to overcome her condition. Devora thought it was the end of her life but was able to recover from the experience and is focused on living her life to the fullest. “I am very independent and try to have nothing defeat me.” She now spends a lot of her free time at her community church, singing in the church choir and serving as a greeter for bible study.

She does experience complications with getting to and from her doctor’s appointments. Due to her physical disabilities, she is approved for 12 (6 roundtrip) Medicaid non-emergency transportation rides a month to get to and from medical appointments. Devora states that she has numerous physician appointments throughout the month and sometimes they exceed the 12 slots available. “I have a daughter that can sometimes take me but she has her own family to take care of.”  Due to transportation difficulties throughout the month, Devora has had to postpone medical treatment. She is hoping that improvements can take place for the Medicaid transportation program to help all Arkansans get to necessary doctor visits.


Valencia

Valencia enjoyed her career as a Metal Pressman until she hurt herself on the job. Due to the injuries sustained in the workplace, she became disabled and had to quit working. Thankfully, Valencia was able to receive Medicaid in order to manage her current physical condition.

This wasn’t the first time that Valencia was able to receive Medicaid benefits. When she was younger, she received benefits for herself and her children. 

“It has helped myself and my children with being able to get the proper medication they need because they have asthma and one of my kids has sickle cell.”

Medicaid allows Valencia to manage her recent Diabetes diagnosis. “I am diabetic and I am allergic to pretty much everything, so it helps me to be able to get my epi-pen and the medicine that is needed for myself.”

         Valencia has experienced many positive benefits with her Medicaid coverage but she feels there are needed improvements for its transportation system. “So It can change with, for one, the availability slots that we get when we are trying to get back and forth to the doctor’s office. There are not enough available slots for us to be able to go to the doctor throughout the year.” Currently, Medicaid beneficiaries who receive private health insurance (non-traditional Medicaid) receive 8 units of transportation per year (4 round trips). If they need additional units, they must contact Medicaid for approval. “You can call and ask for additional slots but you have to call, they have to approve it, and they have to get back to you on that.”

         Valencia is looking forward and hoping to accomplish some of her personal goals. “So what I would like for my future is to have my own home with you know a car. along with maybe having a horse and two chickens along with being able to go fishing, skating, just doing a lot of outdoor activities that I can’t do right now.”


Windell

Windell, a veteran of the United States, and his wife are residents of Hope, Arkansas. His wife currently has had Medicaid for 15 years. As a result, his wife has been able to get healthcare services, but unfortunately, she has only a limited number of twelve visits per year. A few years back, she had surgery on her shoulder, but she could not complete the full physical therapy sessions because she ran out of visits covered by her insurance. Windell states, “with 12 visits approved by Medicaid, it has been hard due to my wife and I being older during this time of year because we are forced to save medical visits. In case my wife has to fight illnesses such as the common cold and COVID-19 at home.  Medicaid considers physical therapy as a medical visit, and we can use half of those limited visits during physical therapy.” If she only receives twelve medical visits a year and attends six physical therapy visits, that leaves six visits for other medical issues, including wellness visits. This is very concerning for Windell because his wife also suffers from high blood pressure and seizures. 

Last year, Windell’s wife contracted COVID-19. She could not receive the prescribed breathing medication to help her with symptoms because Medicaid would not approve of it. This was not the first time that Windell’s wife had experienced this. Medicaid also has denied the blood pressure medication she had been prescribed for years that was working well at managing her condition. Her doctor had to begin prescribing different medications to treat her condition. Windell states that at one point, she had been prescribed three different blood pressure medications to take all at once. This seemed to be the cheaper coverage route for Medicaid, but it would have been more convenient for his wife to be prescribed and pay for one pill. Windell’s wife states, “It’s good to have some form of medical insurance, but it is hard when you get denied a lot of treatment and medications. Each time a physician prescribes a medication that is working, then Medicaid won’t pay for it.” 

 In addition, 11 years ago, Windell’s wife was diagnosed with cancer. Prior to that, she was having back pain and the doctor would never do a CAT scan because Medicaid would not authorize her to have a CAT scan for years. Finally, when his wife was able to get a CAT scan, she was diagnosed with cancer of the kidney. Half of her kidney had to be removed. Windell states, “had they caught it earlier, and Medicaid covered the CAT years ago, we could have prevented half of her kidney being removed.” They finally had a CAT scan due to a nurse practitioner documenting the “right” words for his wife to get tested.

“There is a communication problem between the doctors and Medicaid. People with preexisting health conditions always have a problem.”

To solve the issues with families similar to Windell’s, he suggests that Medicaid offers a premium to be treated better by physicians. The couple is praying that their experience with the coverage provider will get better.

Listen to a snippet from Windell’s Medicaid story.

HT

HT  has recently been experiencing some challenges with her Medicaid coverage. HT informed that due to the limited amount of appointment slots given to her each year, she has been unable to see all her providers for the multiple medical conditions that she has. HT has 7 doctors and is only allowed 12 slots per year to go to the doctor. HT has recently had to postpone a visit to one of her specialists because Medicaid will not cover the appointment unless she goes to him in the following month.  HT is in constant pain because she cannot go to the pain specialist. “Right now, I am dealing with pain because Medicaid will not pay for me to see another specialist until next month.” 

HT also discussed the out-of-pocket costs associated with her coverage. “When I go to the doctor they see me, but they send me a bill. This year alone, I owe over $2,000 because they didn’t pay for this or pay for that. Medicaid refuses to pay for my leg surgery, I had a total knee replacement, and they refuse to pay for that or the x-ray. The doctor had to X-ray my leg after surgery to make sure everything was right, so can we please get some help?” This has been a difficult situation for HT because she does not have the money to pay for the needed medical treatment required to live a fulfilling life.  “When I get through paying my bills, I have access to $400, but that doesn’t go far.” HT is hoping that Medicaid will change its rules on what procedures will be covered and expand the slot allotment so individuals with multiple conditions can have adequate access to care.