When you talk with Fay Petersen, it’s impossible not to smile. Her nickname is FoxyFay. She is smart and resilient, and she still manages to laugh at the absurdities and hardships of life.

Like many low income Floridians over age 50 who have done physically demanding work their whole lives, Fay now finds herself with serious chronic health care needs. And her body that simply cannot do much work–even though she wants to.

Fay would love to work full time, but there is no way that is possible. It’s hard enough for her to do minimal part time work. Sometimes her legs just don’t support her. After one day of work, when she’s on her feet all day, she often lands back in bed for a week. And when she gets up, has to get her strength back again.

Then suddenly—-as if life was not hard enough–she got a notice from DCF on April 28 that said “Medicaid ending on May 31, 2023. ”

The notice she received, like many of DCF’s notices, was confusing. It was 8 pages long. On the 4th page, it said that Medicaid will end for her daughter and her on May 31, 2023. Multiple reasons were listed, but it did not say which reason(s) applied to her and which to her daughter. Adding to the confusion, her DCF ACCESS screen’s “Explanation of Case Action” on May 3 said “SYSTEM GENERATED DO NOT USE MEDICAID CONTINUED DUE TO COVID PHE.” The notice also did not tell her where or how to appeal. She learned that from an internet search which led to this Q & A on the Florida Health Justice Project’s (FHJP) website. This Q & A explained that parents who no longer have a minor child will lose Medicaid with the end of the pandemic related continuous coverage requirement. Because Fay’s youngest child turned 18 in September, she is no longer eligible for Medicaid as a low income parent, even though her income is well below the poverty level.

The threat of losing Medicaid is devastating for many reasons, including the loss of coverage for daily medications that have been critical to managing her thyroid condition and depression. In addition, Fay has a long awaited abdominal surgery scheduled for June. Her Medicaid managed care organization had refused to cover it. But Fay, on her own, successfully appealed the denial of coverage to an administrative law judge. A successful appeal against a Medicaid managed care organization is something very few Medicaid recipients ever accomplish. But after reviewing the medical evidence Fay presented, including pictures of her stomach, the judge found that the surgery was medically necessary to repair an appendectomy that had not closed properly. Her stomach had been left inverted, and she was subject to chronic infections from external moisture. Fay is also awaiting a fitting for partial dentures, also long overdue and scheduled for June. Without Medicaid, her perseverance in finally getting the medical services she needs will “all be messed up.”

 
Fay had hoped that the federal marketplace might provide an option. But she watched FHJP’s video explaining that Floridians with incomes below the poverty level are in the “coverage gap.” The coverage gap is the result of the Supreme Court’s 2012 ruling that the Affordable Care Act’s requirement that states expand Medicaid to cover all low income uninsured adults up to 138% of the poverty level, would, instead, be a state option. Florida is one of only 10 states that still refused to expand Medicaid and “close the gap,” so that people like Fay could have insurance.

“It’s absurd, You can’t be too low and you can’t be too high.” Fay observed. “I’m stuck because my income is too low; I'm stuck because I can't make my body work more hours; and I'm stuck because I'm not yet old enough for Medicare,” she said. “I either have to push myself to work harder or push myself to get older.” ... But neither are options for FoxyFay.