STILL DENIED COVERAGE: The first letter Julie received from DHS.
This Monday, I spoke to a woman in Rogers named Julie, one of the 36,000 Arkansans who lost insurance at the end of July as a result of the Arkansas Department of Human Services' troubled eligibility redetermination and renewal process
for beneficiaries of Medicaid.
Julie, 53, is self-employed. (She asked that I not use her last name for this story.) She makes a modest living cleaning houses and painting and staging interiors in Northwest Arkansas. Until the beginning of August, she had a Blue Cross Blue Shield plan paid for via the private option
, Arkansas's version of Medicaid expansion, which paid for several needed prescriptions.
Before that, she purchased a fairly bare-bones insurance plan for herself out-of-pocket, which she professes she was content with. "It was fine," she said. However, she described the private option insurance as "amazing."
"I felt guilty for having such good insurance and it costing me nothing, but I decided to take it as a blessing," she said. "I took care of some things I hadn't taken care of before ... I hadn’t been to a gynecologist in about four years, so it allowed me to get my pap smear, a mammogram ...[And] I was excited because all my bloodwork was OK — all my cholesterol was in line and everything."
"Oh, and my allergies — that was another thing I was able to get help with. ... That's been fabulous," Julie continued. She'd always suffered from severe allergies, and the private option insurance allowed her to see a specialist — plus, prescription nasal spray and oral medication to make her condition and its associated aches and fatigue more manageable. (She said that's especially important, given her line of work: "One of my clients has three indoor Golden Retrievers!")
"Then, bam, you're cancelled," she said. Her private option policy was terminated at the beginning of August.
Because Julie runs her own small business, she has no employee wage data with the Department of Workforce Services
and therefore was flagged by the DHS' automated system as needing additional income information to determine her eligibility for the private option.
She recalls getting a letter in the mail in early July from DHS that requested the additional information, "but it only gave you a couple days to get your stuff turned back in."
Indeed, DHS only gives beneficiaries a 10-day window to respond to such a request — an arbitrarily short amount of time. Gov. Asa Hutchinson
has refused to budge on the 10 days
, which he and DHS Director John Selig
insist is actually longer than it seems, due to additional flex time the state builds into the process. But that still may not be enough time to make up for the delays and hangups that the state also, inadvertently, builds into the process by simple virtue of the size and complexity of the task it's set for itself.
Upon receiving the letter, Julie contacted her insurance broker (who'd helped her get set up with a private option plan to begin with) then began gathering proof of her low income as a self-employed person.
"I had all my receipts — my cleaning supplies, my gas. It took a few hours to get together, but I wanted it to be right. I mailed it certified mail on July 8, and I have the [post office] receipt from that," she said, a few days after she says she first saw the request from DHS.
"And then as soon as I sent it off, I got a letter saying I'd been denied."
The termination couldn't come at a worse time: After a nine-hour painting job at the home of one of her clients, Julie recently injured a muscle in her side and now can't move one arm without experiencing pain.
"I was up and down on a ladder painting these vaulted ceilings. I think my body just revolted," she told me, laughing. But because she's got no insurance, she said, "I just went to Walgreens and bought a sling for 12 dollars," she said.
"I’m still working, but I can't mop. That's really hard on the muscles in your side. ... I told my clients, 'I can do everything but mopping — just deduct whatever you want' [from my pay]."
Also, the day she lost her insurance, she had a check up scheduled with her allergist. "I had to call and cancel it. The next opening’s not til February, but it doesn’t matter — I can’t afford it now."
She says she won't seek care without coverage except as an absolute last resort, because she's been down that road before. "You're trying to be responsible, to not run to the ER without insurance. ... One time, at one client's home, I fell down a flight of stairs. I fractured my foot, my neck, and wrenched up my right side. ... Finally, I did go in to the ER, because I had walking pneumonia, too ... I still have a bill for $500 that I owe them, and it makes me upset because I am not that kind of person who tries to abuse the system. I take what I do seriously, and I try to be very upfront about what I need to do. I want to get that paid off, but you just can't seem to get ahead with certain things."
So what happened here? One question is when Julie received her first letter from DHS. The first notification from DHS (an image is above, with her personal information redacted) is dated June 21 — but Julie says she received the letter only a few days before July 8, when she mailed her reply. If that is true, she may not have even received her notification until after the 10 day window had already expired.
It's possible she's wrong about the date that she received the request. It's also possible that the letter was simply delayed in its arrival. It wouldn't be the first such anecdote
Like almost everyone else we've talked to who has lost their insurance, Julie said she also found it difficult to get information about what to do next after she sent in her information.
"I called down there to check on the status of it ... and the phone would just ring off the hook." That's bad customer service, she added. "I had my own business in California, and I did wedding planning. This is not how you treat anybody. This is a bunch of crap. ... I’m not trying to make a big wave about things, but I just get frustrated. It’s like, here’s all of the paperwork, here’s this, here’s that. And you still get screwed around."
I spoke to Julie on Monday. On Tuesday, Gov. Asa Hutchinson announced that a processing backlog at DHS had been cleared
, and thus the state could move ahead with its troubled Medicaid eligibility verification process without any changes to its extremely short window of response time, despite concerns
Today — Friday — I checked back in with Julie to see if her coverage had been reinstated yet.
"I've not heard a peep," she said. "And it stinks." She said her arm is doing better but still hurts.
"I may have to just have to change everything I do," she said, half-joking. She's thinking about applying for a desk job or with the school district, although she's reluctant to give up working for herself. "I really like having my own business, because sometimes I might work 12 hours a day or sometimes I only work four," she said.
Although Julie admits the insurance she had previously wasn't great, she said it was sufficient, and she wonders why she was forced to switch to a new ACA-compatible plan only to be kicked off again. Most of all, she just resents all the turmoil: "It’s like a roller coaster. I like to ride 'em, but i don’t like to live 'em."
Julie emphasized to me over and over that she had genuinely mixed feelings about getting insurance through a Medicaid program, because she values her self-reliance so emphatically. She doesn't want to take anything she perceives as a handout, and she's also anxious that people might judge her for having private option coverage. As we talked, she kept apologizing for small things that she felt self-conscious about, things she worried might signal she was too well-off to legitimately receive any sort of assistance — for example, the fact that she has an iPad, a gift from her adult sons.
"I try to be as independent as I can about anything as I can," she said. "I could wear grungy clothes and a bandanna and go to DHS and say 'I need food stamps and I need HUD,' the full Monty. But at the same time, I’m like, ‘I don’t want to do that.’ You know? And it does make it frustrating. You just do what you can do." She laughed again. "At the moment, I’m just wearing my sling and working with one arm."