West Virginia Public Broadcasting

Us & Them: Navigating Post-Pandemic Medicaid

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Trey Kay, Christina Stella

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Our health care systems continue to struggle from aftereffects of the coronavirus pandemic. 

The most recent example spotlights Medicaid — a joint federal and state program that provides health coverage for more than 90 million Americans with limited resources. After several years of continuous coverage, now everyone must reapply for eligibility. 

In this episode of Us & Them, host Trey Kay reports more than a quarter of West Virginia residents rely on Medicaid for their healthcare. It pays for three-quarters of West Virginia’s nursing home residents, and nearly half of the state’s school kids use Medicaid to pay for their annual checkups. However, the application process is finding many ineligible because of changes in personal information and contact data that weren’t updated in the system. 

Join us as we look at the ‘unwinding’ of Medicaid, as millions of the nation’s most vulnerable struggle to maintain their health coverage. 

This episode of Us & Them is presented with support from the West Virginia Humanities Council, the Daywood Foundation and the CRC Foundation.

Subscribe to Us & Them on Apple Podcasts, NPR One, RadioPublic, Spotify, Stitcher and beyond.

A photograph of a middle age woman with blonde short hair, blue shirt and blue necklace, wears a dark blue cardigan.
Tricia Brooks, a research professor at the Georgetown University Center for Children and Families, parses out the nitty gritty details behind Medicaid access to explain how Medicaid coverage changed under the pandemic. The re-enrollment process for Medicaid involves millions of people, but the government cracking down on eligibility isn’t new. Like many safety net programs, Brooks told Us & Them’s Trey Kay that Medicaid is vulnerable to the push and pull of politics in Washington.

“In 2018, there were efforts made by the administration at that time to have a chilling effect on Medicaid and Medicaid enrollment for kids dropped by one million kids. And that same year, the uninsured rate for kids went up by a half a percentage point. We’d gotten down to about 5 percent uninsured kids. If we’ve lost 3.5 million, we’re talking about another 50 percent increase in the share of uninsured children in this country. And that would be a real travesty after decades of working to try to bring health coverage to almost every American child.” — Tricia Brooks, Georgetown University Center for Children and Families

Photo Credit: Georgetown University
Director Craig Robinson oversees Cabin Creek Health Systems, a Federally Qualified Health Center (FQHC) in West Virginia. Cabin Creek, like other FQHCs, exists to give low-cost care to people in need. Robinson showed Trey Kay the 14-page Medicaid application the government sent out after the COVID-19 health emergency ended. He said people are required to fill it out and send it back, to determine their ongoing eligibility for Medicaid coverage.

“I’ve actually tried to complete it [the form] myself. And I couldn’t get through it because I couldn’t understand what they were asking for. They want to know about the situation of everybody in the family, including their medical situation. They want to know about your assets, and I had no idea that assets mattered in terms of Medicaid eligibility. I thought it was all income. But they’re asking for, what’s in your checking account, what’s in your savings account kind of thing. How do I fill this out in a way that I don’t mistakenly declare myself ineligible?” — Craig Robinson, director of Cabin Creek Health Systems, Charleston, West Virginia

Photo Credit: Trey Kay/West Virginia Public Broadcasting
Jake Van Horn is a psychologist and community impact officer for Cabin Creek Health Systems in Charleston, West Virginia.

“It’s extremely short sighted to think that the upfront or initial investment in something like Medicaid doesn’t pay you dividends, in the long run. A community being better put together. Having better health care creates better employees, creates better employment opportunities, creates growth, creates better parents, creates better kids, creates better caregivers. People not struggling so much to maintain basic health, does create a more advantageous society.” — Jake Van Horn, Cabin Creek Health Systems, Charleston, West Virginia

Photo Credit: Trey Kay/West Virginia Public Broadcasting
Katie May, psychologist and clinical director for Cabin Creek Health System’s Comprehensive Addiction Recovery Program, said that many of her substance use disorder patients don’t have time to parse through Medicaid’s 14-page re-enrollment form that’s full of legalese.

“Some of them might be experiencing homelessness. I was on Medicaid during graduate school and just graduated a while ago. And so when they started doing these annual reviews again, I was getting call after call from Medicaid to do my reviews and I was thinking, ‘How are my patients missing these reviews? They won’t leave me alone.’ But it’s also a privilege that I’ve had the same phone number for 15 years and that I have an address forwarding that they were able to keep up with me. Some of my patients, for various reasons, have a different cell phone number every couple months. Whether it’s their phone is being stolen; they’re losing their phone; they can’t afford a service and are having to change services. So, yes, a 14-page application, but that’s even if they get it. And then my patients are coming in and the first time that they’re finding out about this is us telling them, ‘Oh, it looks like your Medicaid has expired.’ And then there’s panic, of course, because that’s how they get their treatment. That’s how they get lifesaving medication.” — Katie May, Cabin Creek Health Systems, Charleston, West Virginia

Photo Credit: Trey Kay/West Virginia Public Broadcasting
It’s true that publicly funded medical insurance opens the door for a lot of Americans to take better care of their health. Deedra Toppings, from Branchland, West Virginia, has had significant health challenges, some of which came during the pandemic when she was not working and eligible for Medicaid. COVID-19-era policies gave Deedra’s family a taste of stable insurance that actually worked for them. But when she returned to work, the circumstances changed. As Medicaid returns to business as usual, people are losing resources that made their lives better.

“I feel like we’re being punished because we want to work and we want to better our lives and make sure our children have what they need. When I didn’t work, and we didn’t want more for our lives, we would get the Medicaid and it would help with the hospital bills, the doctor bills, whatever. But because we both want to work, I mean, we do not make a ton of money, we don’t have extras, we don’t have all of this stuff. It just kind of feels like we’re punished, because when we work, then we don’t get the help that I necessarily need for my health.” — Deedra Toppings, Branchland, West Virginia

Photo Credit: Trey Kay/West Virginia Public Broadcasting
James Hairston, 63, is a disabled coal miner living in St. Albans, West Virginia. He told Trey Kay that his disability occurred when “1,800 pounds of sandstone and coal” collapsed on him and pinned him to the mine floor. Hairston and his wife are both disabled. He used to get Medicaid benefits, which meant he could use home health care. That provided help with household chores and meals. He didn’t see it as a handout, just some help. Under the COVID-19 emergency declaration, Hairston couldn’t be removed from Medicaid. But once that ended, the state reported that he made too much to qualify.

“It’s a real hurting feeling. I’ve worked to provide a good living for my wife and kids. It’s hard for me to look at it and say, ‘Well, you know, you cut me off.’ And I didn’t bring this pain and all this stuff to myself. It’s just, I mean, I love what I was doing and I miss it so bad and I still had a lot of good years left in me.” — James Hairston

Photo Credit: Trey Kay/West Virginia Public Broadcasting
James Hairston shows the crack in the miner’s helmet that he was wearing the day the mine ceiling fell in on him and ended his coal mining career.

Photo Credit: Trey Kay/West Virginia Public Broadcasting
Eric Hicks works with a range of Medicaid clients, including James Hairston, through the local home care company he runs called Right At Home. Right At Home is a nationwide franchise and in West Virginia, most of the company’s business comes from Medicaid patients. Hicks says when the government stops paying for a person’s home care, it puts families in a bind. Most times, they’ll try to find friends or family to help out. If that’s not available, the only other alternative is often a skilled nursing facility.

Trey Kay asked Hicks what Medicaid gives someone like James Hairston. The answer is simple: autonomy.

“There is absolutely a place for skilled nursing facilities and the services that they provide. When a person graduates from in-home care, that’s where they go, because we cannot meet all their needs. But it’s that gap in between, that people want to stay at home and they have the ability to stay at home if they have a little bit of assistance. They want to have all their things that they have at home and not be forced to leave their home to go to a place that they’re not comfortable with. A lot of people don’t want to be in a more institutionalized setting, they want to be able to comfortably have as many of their family and friends over to visit whenever they want to come by, not be restricted by time constraints, et cetera.” — Eric Hicks, president of Right at Home, Charleston, West Virginia

Photo Credit: Trey Kay/West Virginia Public Broadcasting

Check out our colleague Emily Rice’s AP of the Virginias award-nominated series Unwinding Medicaid.

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