Prescription for Disaster: A Medicaid Malady

By Elyssa D. Durant, Ed.M.

I just returned from my monthly visit to the doctor, and subsequently a visit to the pharmacy. Nothing unusual with my medications—they have been stabilized for several months. Yet this time the pharmacy could not provide my customary refills. My Medicaid will not pay for them. Not this time.

Together the whole lot of medications costs just less than $900. Nine hundred dollars that I don't have, and nine hundred dollars that I have no way of getting. I have no other benefits, no Social Security checks to count on; no disability payments to pull together; no Medicare to meet me when the bottom falls out, again.

This surely is not the first time my Medicaid has not come through as a reliable source of payment. It is not even the second or third time. It's more like the eight or ninth, maybe more often than that. I only recently qualified for Medicaid some eight months ago! Since then, I have already acquired several thousand dollars in unpaid medical expenses that have made their way to collection agencies.

I constantly ask myself why does this happen to me? Am I part of some diabolical scheme to do away with public health efforts? Silence the noisemaker! Or is it just a coincidence that I spent three years in a doctoral program studying health law and policy specific to mental health and Medicaid. Don't they know how much more it hurts me to know exactly which systemic cracks I am falling through? Why have I encountered so many random barriers to health care in addition to those obstacles strategically placed in the system? We all know them: the endless forms, the incompetent employees, the negligence that already works to deter consumers such as myself from using the public health programs to which we are entitled. Yes, entitled. Medicaid is in fact an entitlement program no matter what they would have us believe.

Don't they know who I am? Who I could be? Who I might be if only my mental health and medications would remain stable? If only my health could be stabilized, I could live the rest of my life in rhythm without having my peace of mind tampered with by bureaucratic negligence and oversight. Without having my benefits tampered with by bureaucratic negligence and oversight! I could be a real noisemaker, if only…

Unfortunately, no one in the Medicaid office knows who I am. I remain a faceless, quantifiable case number who means nothing to them. And I am not alone. But I need your help. Together we can fight to change Medicaid prescription limits and managed care formularies. I am not alone. Let your voice be heard.

Editor's Note: To fight the powers that seek to save money at your expense and reduce benefits like Medicaid coverage, join groups like NYAPRS (www.nyaprs.org, 518-436-0008), NAMI (www.nami.org, 212-684-3365), MHEP (www.mhepinc.org, 518-434-1393), CHOICE (914-576-0173) or NMHA (www.nmha.org, 800-969-NMHA).