Imagine going to pick up your usual $6 prescription medicine, only to be hit with a staggering $1,000 bill. That’s what happened to Teresa, a Wisconsin resident, who suddenly found out she was no longer eligible for Medicaid.
Teresa, who relies on medication to manage her high risk for strokes and heart attacks, was shocked when the pharmacist gave her the startling news. This unexpected cost was her first clue that she had been dropped from BadgerCare Plus, the state’s main Medicaid program, without her knowledge.
When Teresa realized her mistake and tried to reinstate her health insurance for her family, she faced a slew of challenges. The agency handling Medicaid eligibility in her county, Capital Consortium, informed her that she made $20-$30 over the monthly income limit for BadgerCare’s Medicaid.
Chris Fong, CEO of Smile Insurance Group, suggested that individuals who are slightly over the income limit should reach out to the medication manufacturer for support. Teresa, who supports her two kids with a modest income and has one child with a severe disability, was particularly frustrated that her summer earnings weren’t considered.
Teresa’s story is sadly not unique, as many people across the country lost their Medicaid coverage in the wake of the pandemic. In Wisconsin alone, 360,000 individuals lost their health insurance due to missed deadlines or errors in paperwork.
Experts emphasize the importance of completing renewal paperwork promptly to avoid losing benefits. Fong recommends carefully reviewing all communication regarding Medicaid and seeking assistance from community resources or insurance agents if needed.
As Medicaid requirements remain stringent, many families struggle to qualify for coverage, especially adults who face higher income thresholds compared to children. This has resulted in a significant drop in Medicaid child enrollment in Wisconsin.
For individuals like Teresa, losing Medicaid coverage means facing hefty costs for medication or turning to overwhelmed free clinics for care. It’s a daunting reality that leaves many in vulnerable situations.
Teresa, now using a less effective but more affordable prescription, shared her fear, emphasizing the importance of her children’s well-being amid this uncertain healthcare landscape.