Lily
Miami, FL
Lily, seven months pregnant, was erroneously terminated from Medicaid, and she had to spend countless hours getting her insurance back.
Lily is busy preparing for the birth of her third child, due just two months from now. Her pregnancy is considered “high-risk,” so she has to be very careful with her activities and go to extra doctor’s appointments. Nevertheless, while she could, she worked extra hours at her part-time job to make up for the work (and income) she will miss after the baby is born.
Lily has been on Medicaid since last year when her current pregnancy began. Her two sons were also on Medicaid, but the older one became ineligible earlier this year after the continuous Medicaid coverage requirement ended. When Lily submitted an application to enroll him in Florida Healthy Kids, and reported her and her husband’s most recent income, she received a notice from DCF saying that she is no longer eligible for Medicaid (even though she was not up for renewal yet) because her “household income is too high.” The notice also said “You are receiving the same type of assistance from another program,” which she didn’t understand.
Lily could not tell from the notice how DCF was calculating her family’s income, what the income limit is in order to remain eligible, or how many people DCF counted in her household (she had done her own research and knew that the unborn baby should be included).
This notice of ineligibility caused Lily to panic, because without Medicaid, she will not have coverage for the remainder of her pregnancy or the delivery of her baby.
“I never could have dreamed that by being responsible and working a few extra hours to prepare for the time I would not be able to work, I would end up losing Medicaid coverage for the rest of my pregnancy.”
Lily turned her worry into action and did some research. She determined that according to the Medicaid law, once she was eligible for Pregnancy Medicaid, she remained eligible–regardless of her income–throughout the pregnancy and twelve months afterward. Lily called DCF six times over three days, racking up a total wait time of over nine (9) hours! But everyone she spoke with told her that her income was too high; none of them seemed to know about the law she had found. Nor did anyone at DCF tell her she could appeal. Instead they told her to submit a letter through her Access account explaining that her current higher income was unusual and temporary. She did this, but didn’t hear anything more from DCF.
Lily reached out to the Florida Health Justice Project and learned how she could appeal her loss of Medicaid. Filing an appeal is supposed to keep the coverage in place until the appeal is over, but it didn’t happen that way for Lily. Her Medicaid was cut off on August 1st, and a few days later, while she had no insurance coverage, she went into early labor and was hospitalized. It was a scary time. Worse still, when she was discharged she couldn’t fill the prescription she needed to stop the contractions or attend her appointment with the high-risk obstetrician. Lily finally got DCF’s computer to show that she had coverage, but then she learned that two more computers needed to be updated: the one at the Florida Agency for Health Care Administration (AHCA) and at her managed care plan. Restoring coverage on all three computers took 22 days, even with her calling every day and with the help of FHJP. The normally strong and determined Lily admitted,
“There were days I cried and felt like giving up. But I knew I couldn’t, because my family needs me to be healthy, especially my unborn child. So I wiped my tears and kept calling. I just don’t understand why the state makes this so hard.”
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