By Melissa Walker

As a health insurance navigator, I meet with various types of individuals and families throughout the 17 localities that I serve. With the implementation of the Affordable Care Act it has allowed hundreds of thousands of Virginians to find affordable health insurance options that they did not previously have. However, there are still many Virginians who still do not have an affordable health insurance options. Many of these individuals fall in the Medicaid gap where Medicaid was not expanded to cover them.

These individuals’ income is also too low to qualify them for subsidies through the health insurance marketplace. To qualify for marketplace subsidies, also known as advance premium tax credits, an individual must meet a minimum income guideline. For a taxable household of one that income is $12,060 and for a household of four the income is $24,600. If your income is below the minimum requirement, then you do not qualify for a subsidy to lower the cost of health insurance for yourself and or your family.

You can purchase a plan through the marketplace however, you are responsible for 100 percent of the monthly premiums. In most cases that amount is not affordable.

I am a concerned citizen that see the impact that not having comprehensive health insurance has on people. Some of these people feel like they do not have a voice or that no one would care about their story. I would like to be the voice for these people. I would like to share with you a few stories of individual who I have met with personally that are still uninsured because the Commonwealth has chosen not to expand Medicaid to assist these adults. I will group the individuals I am discussing tonight in five categories: childless adult, low income-parents, young adults who age out of Medicaid, individuals who are waiting for disability determination, and older Virginians.

Childless Adult

The only adults that currently may be entitled to full Medicaid coverage in Virginia are parents of children under the age of 18 who live with them, pregnant individuals, disabled individuals and low-income adults over the age 65. I met with a 28-year-old single male from Spotsylvania who is currently unemployed. He says his unemployment is due to mental health issues that limit his ability to maintain employment for more than a few weeks at a time. He does not anticipate making more than $6,000 for the year. He is not consistent with attending his appointments with his psychiatrist or therapist due to his lack of income. He must borrow money from family members or friends to attend his appointments. He also is unable to follow an appropriate medication management schedule for this same reason. He was recently hospitalized at Snowden at Fredericksburg due to a threat to harm himself. He is in the Medicaid gap and does not qualify for full Medicaid. He recently applied for the Governors Access Plan (GAP) which is a limited Medicaid program. If he qualifies for this program, it will allow him access to meet with his doctors and obtain his medications. However, with this program he will not have coverage for any hospitalizations that may occur during his time of coverage. His has an extensive history of hospitalizations and there is a high probability that he will be hospitalized again before the end the year.

Low-income Parents

Virginia does have a Medicaid program for low-income parents called “Low Income Families with Children (LIFC)”. This program allows some low-income parents to obtain health insurance, but the income guidelines are very restrictive. If a family of four makes more than $12,372 annually in the City of Fredericksburg and $8,136 annually in the surrounding counties, then the parents do not qualify for this program. I met with a 30-year-old mother of three who lives in King George. She works part-time at a local pharmacy, making about $16,000 a year. Her employer does not offer health insurance for part-time employees.

When I met with her she had been to the emergency room three times in the last month. The emergency room doctor determined that she has several gallstones and will need to have surgery to have her gall bladder removed. To qualify for subsidies through the health insurance marketplace a household of four must have a minimum annual gross income of $24,600. She is in the Medicaid Gap and will not be able to purchase health insurance through the marketplace because it will not be affordable for her. She is a mother with minor children however, she earns too much from her job to qualify for the LIFC program. She is very limited in her healthcare options to get the necessary surgery that is needed.

Young Adults who age-out of Medicaid

Virginia offers health insurance coverage to children under the age of 19. For the children to qualify for Medicaid a family of four must make less than $36,408 annually. The Families Access to Medical Insurance Security (FAMIS) program will allow that same family of four to make up to $50,430 annually for the children to qualify. However, once that child turns 19, their Medicaid or FAMIS coverage stops unless they are in foster care or disabled.

I met with a 19-year-old male who is a senior in high school in Stafford County. He just recently moved in with his grandfather who is financially supporting him after his mother left him to move out of the state. He has no income because he is a full-time high school student. He has aged out of the FAMIS and Medicaid program. His grandfather is planning to support him up until he graduates from high school in June then this young man will be on his own. Because he lives in Virginia he does not have any affordable health insurance options available to him. If he becomes sick or injured, he will either go to urgent care or the emergency room and will be responsible for all his medical expenses. It has to be difficulty for him to have to worry about not getting sick or injured because you have no job or insurance instead of focusing on graduating from high school in a couple of months.

People Waiting for Disability Determination

Virginia’s Medicaid program does offer full coverage to some individual who are declared “disabled” by the Social Security Administration. It is a long process to be declared disabled and can take anywhere from several months to years. I met with a 54-year-old single male from Fauquier County who has several health issues that has limited his ability to work. He has applied for disability benefits with the Social Security Administration but has yet to be approved for Social Security Disability Insurance (SSDI). He currently has no income and is in the Medicaid gap. He is a patient at a local free clinic so that he can be seen by a primary care physician and to obtain medication for his high blood pressure, diabetes, and high cholesterol. He is very concerned that his disability will cause his health to decline to the point where he will need to be hospitalized. He also feels that not have health insurance has limited his ability to effectively treat all his health needs and that his health has declined over the past year while waiting to become eligible for SSDI.

Older Virginians

There are older adults who have chronic health issues that are not serious enough for them to be identified as disable but are still in need of daily prescriptions and follow up care with their doctors. With being uninsured it makes it difficult to manage these health issues due to minimal access to health services, screening, and medication. I met with a 60-year-old single female from Fredericksburg who has health issues that requires daily medication and follow up care from a primary care physician. She has worked full time and receiving health insurance from her employers for the last 20 years up until she was laid off from her job in June 2017. She was receiving unemployment compensation after she lost her job until it ended in December 2017. She has been looking for but has not been able to find another job. For 2018 her only income is $664 a month in a retirement pension she receives from her ex-husband. This is another individual in the Medicaid gap who does not qualify for subsidies through the health insurance marketplace because her income is less than $12,060 annually. She also does not qualify for Medicaid and she is not old enough to receive Medicare.

As a concerned citizen of the Commonwealth of Virginia I want to express the importance of Medicaid expansion in our state. Not having proper medical care not only impacts the individuals not receiving the care but it also effects their families and love ones. Imaging having a parent who is in pain all the time because she cannot get the necessary surgery she needs, or being an adult child who is seeing their mother’s health decline because she lost her job and now cannot afford see her doctors or purchase her medications.

These individuals who do not have access to comprehensive health insurance are people we interact with daily. They are our neighbors, the parents of our children’s friends, or even a family member. It is important for us to support them with getting the care that they need.

Melissa Walker, Navigator
Enroll Virginia
Lloyd F. Moss Free Clinic, Fredericksburg