Affordable Care Act impacting those with Medicaid

Apr 18, 2014

The Affordable Care Act expanded eligibility for Medicaid. And the number of applicants in Illinois has overwhelmed state employees, meaning the wait for Medicaid benefits to begin can take months. Illinois Public Radio’s Jim Meadows looks at how that wait is affecting three people in Champaign County.

The three people I spoke with were referred to me by Champaign County Health Care Consumers, which helped them fill out and send in their Medicaid applications back in December. 

Zivar Guyot applied for coverage for herself and her three children on December 5th. Later that month, with the application still pending, the Champaign electrician paid out of pocket when one of her daughters saw a doctor at a Carle Convenient Care clinic for strep throat. But three months later, when Guyot’s daughter had to go to Carle again, the state was clearly late in processing the application.

"She needed to go again in March, and that time, they told me that I should just bring my Medicaid card when it comes through, and they would apply those retroactively. So, I’m Just saving the bills on that one," says Guyot.

Waiting, that’s what patients and doctors are doing, while the Illinois Department of Healthcare and Family Services struggles to process a larger than expected number of Medicaid applications.  

At Promise Healthcare, which operates the Frances Nelson Healthcare Center in Champaign, executive director Nancy Greenwalt says they’ve resolved to provide health care to patients with pending applications, knowing that payment for that care may be delayed.

"I mean, we learned pretty quickly at the beginning of the year that it wasn’t going to be, sort of, what we had budgeted and projected.  And so we’ve made adjustments," says Greenwalt.

Greenwalt says one adjustment is paying extra attention to when Medicaid applications are finally processed, so they can send a bill to the state immediately.

Claudia Lennhoff of Champaign County Healthcare Consumers says many doctors’ offices are making such adjustments for their patients.

"But, I think where we’re seeing a greater impact on those clients is when they go the pharmacy," says Lennhoff.

Lennhoff says that patients in Medicaid application limbo usually have to pay for prescription drugs themselves, or just wait. That’s a concern for one Urbana resident, who’s asked that we don’t give her name, for fear that her pre-existing condition could hurt her chances in the job market.

Her last fulltime job ended in 2012, and her COBRA benefits ran out earlier this year.  Once her Medicaid application is processed, she’ll have to find a new specialist, because her current one is in St. Louis --- and not covered by Illinois Medicaid. But right now, she’s more worried about her maintenance medications. Without them, she says she would be completely debilitated, and she has less than a two months’ supply on hand.

"Once my medications run out, I won’t have those maintenance drugs either. And if I’m fortunate enough to have the application approved, I will have to go through the process of finding a specialist that can help me with my condition."

The two Medicaid applicants you’ve just heard about have been waiting longer than the 60-to-90 days the Illinois Department of Healthcare and Family Services is telling people to expect.

Champaign resident Jim Bean also waited longer than 90 days, but he says his Medicaid coverage is official now, although only after Champaign County Health Care Consumers made a phone call to HFS on his behalf. Bean is unable to work due to hearing loss and back problems, following years working as a rock musician and stage rigger. In recent years, he relied on Carle’s Community Care program for discounts on healthcare, and borrowed money from friends to pay for prescription drugs. Now, with Medicaid coverage, Bean’s he’s optimistic about the future.

"The first thing that changed was, I’m not worried or concerned any longer about not being able to do maintenance on my health. And let’s hope that I don’t need to go to the emergency room. But I know that if I do, it’s not gonna break me," says Bean.

But for many Medicaid applicants in Illinois, the wait to get their applications processed will continue.

Healthcare and Family Services spokesperson Joannè von Alroth says that as of last week, her department had processed more than a quarter million Medicaid applications, but had another half-million applications waiting. She’s not making any predictions on when they’ll be caught up.