Too poor to qualify for financial help

Mar. 05, 2014 @ 09:12 PM

The fact that there are people who are too poor to qualify for financial assistance to help pay for insurance in the health insurance online exchange or “marketplaces” in North Carolina is a concern for Gina Upchurch, the founder and director of Senior PharmAssist, a program that helps get older people get access to medications.

Upchurch said the nonprofit has been screening people and sending those who are eligible for subsidies to get help in signing up for insurance through the exchanges. Some people have gotten “very good subsidies” and were pleased. But she said they’ve also come across people who are too poor to qualify for subsidies through the exchange. People below 100 percent of the federal poverty limit don’t qualify for tax credits, which are available to people with incomes between 100 and 400 percent of the federal poverty limit, according to information on The Henry J. Kaiser Family Foundation website.
“The weird part about it for us – (we’re) helping these folks, but the people with the least means are the ones not getting any help,” she said. “A lot of people, when they call, we go, ‘We’re sorry, you make too much money for this type of assistance,’” she added. “Now, we’re having to say, ‘you make too little money.’”
Durham resident Shirley Glover said she worked for 45 years as a preschool teacher’s aide, and then as a teacher. She said she had good insurance, but when she stopped working, she couldn’t afford to keep the payments up. She said she stopped working as the position she was in was being phased out, and as she was also at the age where she could start collecting Social Security.
She is 64 years old, and will turn 65 – the age at which she’ll qualify for Medicare – in November. She said she did not have health insurance, said she does not believe she brought in enough income to qualify for subsidies through the online insurance exchange. She said she has hypertension, and is able to get help paying for care through a Duke University Health System charity care program.
“My income is just limited,” she said. “So if I have to pay $100 or $200 — that’d be my whole check.”
Upchurch said the problem exists because state leaders didn’t expand the Medicaid program in North Carolina.
Originally, the federal health law planned to urge states to expand their Medicaid programs to people whose incomes are up to what is effectively 138 percent of the federal poverty limit by withholding money for the program from states that did not. However, a U.S. Supreme Court decision in 2012 made the Medicaid expansion an option for states. North Carolina’s legislature and Republican Gov. Pat McCrory decided not to expand Medicaid here.
Had the state expanded Medicaid, many more of Carrboro-based Piedmont Health’s patient population would have been eligible for Medicaid had the state expanded the program, said Brian Toomey, CEO of the system. Piedmont Health is a community health care provider serving primarily the uninsured.
Toomey said the Medicaid program is for the aged, blind, disabled, or for low-income parents with children under the age of 18.
“If you’re a 50-year-old male who is financially eligible for Medicaid, but you’re not disabled, you wouldn’t get Medicaid in this state,” Toomey said. “It would be better for individuals if Medicaid expansion happened, but it hasn’t, and it isn’t going to happen this year.”
Lincoln Community Health Center’s patient population is largely uninsured, said Philip Harewood, Lincoln’s CEO. Center officials were counting on the Medicaid expansion to help get coverage for patients who are uninsured, he said, but the marketplace is “not designed” to address that population.
“The Medicaid expansion would have addressed our patient population that’s uninsured currently,” he said. “The marketplace is not designed to address our patient population, but then we were not just concerned about Lincoln patients. We are concerned about access to care (for) the Durham community.”