Could you live on $791/month and pay additional medical bills?
Posted on February 27, 2012 by Megan Burke
People with disabilities are frequent users of health care and need a wide range of health services, durable medical equipment and in-home services. MO HealthNet plays an important role for people with disabilities by providing access to a range of health care and services not covered by private insurance or Medicare, such as transportation and attendant services.
Since the reduction of the MO HealthNet income limit in 2005 to 85% of the federal poverty level ($791/mo), people with disabilities must incur greater medical expenses in order to access necessary health care and personal attendant services. Many people with disabilities and seniors pay a deductible or “spenddown” each month to qualify for vital services. Some people have deductibles as high as $800 a month. Who can afford that? And now people are being asked to pay even more out of pocket to get their vital services due to a change in how spenddown is being implemented.
One womancurrently uses MO HealthNet, Medicare, and private insurance in order to pay for her medical bills. She is on a limited income, and MO HealthNet is the only source that will help with cost of transportation to medical appointments. She has to pay a spenddown to become eligible for MO HealthNet. Originally she had to pay for the first transportation service of the month, before becoming eligible for MO HealthNet. As of late she has had to pay for each ride until the 11thof every month. She expressed frustration as she was recently informed by her social worker that she will no longer be qualified for MO HealthNet transportation benefits starting in May, 2012 due to the changes to spenddown. This will restrict her ability to access the medical services she needs to maintain her health.
Another woman who participates in the MO HealthNet spenddown program uses MO HealthNet funded transportation on a daily basis in order to attend her dialysis appointments. She stated that her transportation was no longer paid for starting in the middle of January, 2012 and she received no notification that this resource was going to cease. Had she known that her transportation services were going to stop, she would have saved her money ahead of time in order to pay for transportation.
A third MO HealthNet participant has a spenddown of over $400/month. Before the change to spenddown eligibility determination, she would meet her spenddown after her first dialysis treatment. With the changes, they are estimating it will take 10 (or more) treatments to meet her spenddown. She has to pay $8/trip out of pocket for transportation to dialysis three times a week. That’s at least $80 she has to come up with for medically necessary transportation until her spenddown is met. This is money she needs to use elsewhere for groceries, bills, rent, etc. She can’t pay her attendant, so her sister has to work for free until the spenddown is met.
People with disabilities are having to make unthinkable choices. Do they buy life sustaining groceries or life sustaining medical treatment? Do they pay their rent, or pay for life sustaining medical treatment? These are choices people should not have to make. When you are trying to manage a chronic health condition, unnecessary stress, being at risk for losing housing, not being able to eat properly, and not being able to access proper medical treatment creates bigger, more expensive health issues.
We agree with the Center for Medicare and Medicaid Services that the state should not implement these changes until a plan is in place to assure people’s health and safety.
The spenddown issue just reinforces that it is time to make sure that people have access to affordable health care that meets their needs and helps them to remain living in their communities. These are not life’s little extras, but essential health services.
In 2008, the Disability Coalition on Healthcare Reform published a report addressing barriers people face trying to live with MO HealthNet spenddown. Many of the issues addressed in the report ring true today, and are even more harrowing due to the additional barriers created by this change in spenddown.