Who's on Medicaid Might Surprise You

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Chynna Lloyd, 18, is the first in her family to go to college and plans to be a lawyer one day.  Raised by her mom after her dad passed away, Chynna gets her health insurance through Medicaid, and has for as long as she can remember.

Four-year-old Miles Herbrand has a rare genetic disorder that causes seizures and developmental delays. His parents, software engineers with private health insurance, credit Miles' ability to walk and speak in simple sentences to in-school services and therapies paid for by Medicaid.

When 96-year-old Grace Miller's bank account dwindled to just $2,000, she didn't have to move out of the nursing home where she was living. Medicaid started picking up the tab.

People like Chynna, Miles, and Grace (more about them below) don't necessarily fit the popular image of a Medicaid recipient. Many Americans think of those on Medicaid as lazy and unemployed, unwilling to take good care of their health because they know if they get sick, others will pick up the tab. 

In reality, those who benefit from this $545-billion-a-year program are not so easily typecast. More than 70 million Americans, or 1 in 5, use this government program. And they come from all walks of life—including people you know.

It could be your grandmother—one-quarter of Medicaid enrollees are elderly people or disabled adults.

It could be the child next door. About half of Medicaid enrollees are children, many of them with special needs.

The rest are adults without disabilities who earn too little to afford health insurance otherwise. Many of them are working: Six in 10 able-bodied adults on Medicaid have a job. And 78 percent of Medicaid recipients are part of a household with at least one person working full time. Many of those who don't work are caregivers for other people.

According to the Congressional Budget Office, 14 million Medicaid recipients could lose their coverage if GOP plans to overhaul the Affordable Care Act (ACA) become law.

When Family Health Insurance Falls Short

The symptoms weren’t worrisome at first, says Melissa Todaro of her 12-year-old daughter Amber.

In March 2015, Amber began having problems going to the bathroom. Severe stomach pains followed a few weeks later, Melissa says, along with blood in her daughter's stool. A colonoscopy revealed that Amber had a severe case of Crohn’s, a chronic inflammatory bowel disease. To get it under control, Amber had to be put on a feeding tube and receive medication infusions that, Melissa remembers, took 3 hours every three weeks.

After missing her entire fifth grade, Amber, now 12, is feeling better. “She’s back in school and getting back to normal, whatever her new normal is,” says Melissa, a school bus driver who lives in Reading, Pa., with her husband Joseph, a computer desktop analyst, and their other daughter, 9-year-old Sarah.

But Amber will need medical care for her disease for the rest of her life. She still requires infusions every six weeks, which cost $25,000 each, other expensive medication, and frequent doctor visits. Though the Todaros have health insurance for their family through Joseph’s job, it doesn’t cover everything.

“We’ll do anything we can to get the treatments Amber needs. But we only have so much money,” Todaro says.

A friend suggested she apply for Medicaid to cover the gap. When private insurance isn't enough, Medicaid helps pay for long-term medical treatments for children who have special healthcare needs and without regard to family income. For Amber, Medicaid has covered visits to medical specialists, a home health aide to administer infusions, and special vitamins and supplements.

Without that financial help, Todaro says they would probably have to sell their house and move in with her parents.

“Finding out Amber could qualify for Medicaid regardless of our income was the biggest blessing to our family,” she says.

When the Help Comes Through School

Four-year-old Miles Herbrand is one of the 32 million children on Medicaid who are helped by the $4 billion spent every year on school-based services. Miles was born with Snyder-Robinson Syndrome, a genetic disorder that causes seizures and developmental delays, says his mom Lori Herbrand, who lives in Marion, Iowa, with her husband Justin.

The Herbrands are software engineers and have health insurance through Justin’s employer. That covers some of Miles’ medical bills, such as his epilepsy medication that costs $100 per day, after they satisfy their $4,000 annual deductible.  

But Medicaid funding provided through the school district pays for additional services: Miles’ speech therapy, plus physical and occupational therapy. It also covers the teacher’s aide he needs at his preschool.

Lori credits Miles' therapists for the gains he has made. Miles can now walk independently, speak in simple sentences, and—with a teacher's aide—attend school, Lori says. Just as critical, Miles' ability to go to school means Justin and Lori can work full-time.

If Medicaid is cut, Lori worries Miles will no longer be eligible for the extensive therapy and the teacher’s aide. “When he was 1, Miles couldn’t even sit up," Lori says. "The therapy has been critical. He’s active and engaged and able to participate with more normal kids.”

A Lifeline After Money Runs Out

Two years ago, 96-year-old Grace Miller's arthritis made it impossible for her to walk or care for herself. Her family moved her into a nursing home in Chapin, S.C. But the care costs $6,000 per month, and Miller, the widow of a World War II veteran, quickly ran through her personal savings, according to her son William.

Once her bank account dropped to $2,000, William, who lives nearby, was able to get his mom on Medicaid. "Having Medicaid gives her a sense of security," says William, who is retired.

Indeed, Medicaid provides critical funding for seniors because long-term care, from home-health aides to nursing homes, is not covered by Medicare, the health insurance program for people 65 and older. Some 64 percent of nursing home residents are covered by Medicaid, according to the Kaiser Family Foundation.

For seniors to qualify for Medicaid, they must spend down virtually all their assets. Without Medicaid, William says he’d have to move his mom to his home, which he says is ill-suited for her health needs.

“If Medicaid wasn’t there, she’d be in a bind. But not just her, our whole family,” says William. “We’d pay to keep her in the nursing home as long as possible, but we wouldn’t be able to do it for long.”

Working When You Have a Disease

“I couldn’t hold up a tray anymore,” says Elizabeth Nicolosi about why she quit her waitressing job this May. It’s not the first time Nicolosi has had to drop out of the workforce. The 42-year-old was diagnosed with multiple sclerosis in 2008, about the same time she finished her degree in computer information technology.

Nicolosi, a divorced mom of two children who lives in New Orleans, has relapsing MS that requires her to take 10 medications per day. She can go months without symptoms, but when an attack strikes, she is weak and tired, her hands shake, her muscles ache, and she gets dizzy. That leaves her unable to work for months at a time.

She’d like to get a less physically taxing job that provides health insurance. But she says she has been unable to find an employer willing to hire her full-time where she can use her degree because she's been cycling in and out of the workforce.

Nicolosi qualified for Medicaid in 2013, when she had to cut back on work as her MS worsened. Before that, she relied on the National Organization for Rare Disorders foundation for financial assistance.

But it didn’t cover all of her expenses. She would sometimes go months without taking her medications or seeing a doctor. If it weren’t for Medicaid and the medications that keep the symptoms at bay, Nicolosi says she wouldn’t be able to work at all. “I would have been in a wheelchair by now,” she says.

Staying Healthy to Achieve a Better Future

Chynna Lloyd just finished her freshman year at California State University, Northridge. The 18-year-old from Lomita, Calif., the first in her family to go to college, is studying public health policy and would eventually like to be a lawyer. Lloyd knows public health programs well. She, her mom, and her 15-year-old sister have been in the Medicaid program as long as she can remember.

“My family has just always fallen into that gap where we didn’t make enough to pay for our own health insurance,” Lloyd says. Her mother emigrated from Belize in 1996 and worked mainly as a security guard earning minimum wage. Lloyd’s father passed away when she was 15, and for a period of time she, her mom, and her sister were homeless.

Lloyd says Medicaid has been critical for her family. Her sister has severe asthma. “In the winter, when it’s really cold, she has trouble breathing,” Lloyd says. Medicaid covers her inhalers and asthma treatments.

Her mom, who is going to community college in the fall to get a culinary arts certificate to prepare for a job in food service, recently had surgery for gastritis. “She wouldn’t have been able to afford that surgery without health insurance,” Lloyd says.

Lloyd was diagnosed with irritable bowel syndrome last winter during finals. “I was really stressed out,” she says. Her doctor provided some muscle relaxers for the back spasms, allowing her to go to class, and advised her on a diet to avoid flare-ups. “If I didn’t have health insurance, I wouldn’t have gone to the doctor,” she says.

If Medicaid is cut, Lloyd says she’s worried for her family and others like hers who live near the poverty line. “It’s not that people are lazy. I know people who work long hours and can’t afford health insurance,” Lloyd says.

Peace of Mind to Pursue a Passion

Kelsey Swanson, 27, has been in love with theater ever since her parents took her to see a production of "Beauty and the Beast" when she was in fifth grade. Swanson, who lives in Silver Spring, Md., studied theater at Simpson College in Boston.  

She graduated in 2011 and has been working as a theatrical electrician since, freelancing for theaters in and around Washington, D.C. She doesn't get employer health insurance and her income fluctuates—but she loves her profession. "It's a lot of fun," Swanson says.

Even though she is young and healthy, having insurance is important to her. “With my job, it’s very likely I could injure myself. I’m moving heavy things around. I’m hanging 30 feet in the air focusing lights," Swanson says. “If I didn’t have health insurance and got injured, I could miss months of work and not have any income or any way to pay medical bills.”

When Kelsey turned 26, she was no longer able to be on her parents’ health insurance. Her low income qualified her to apply for Medicaid. “It was a very pleasant surprise,” Swanson says. “Living in this area, it’s really expensive. I pay almost $1,000 between rent and utilities, plus student loans. It’s hard to add another $300 a month payment for insurance.”

Swanson says she doesn’t use her insurance frequently because she’s healthy. But after battling a bout of depression in college, she is comforted to know that mental health treatments, should she need them, would be covered.

“I have peace of mind knowing I have it. Should anything happen, I won’t be destitute.“

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