For those not phased out of Medicaid coverage, recipient says system falls short

Thousands of Hoosiers are being phased off of Medicaid following the end of the federal public health emergency. Even for those who still have coverage, there are flaws in the system.

Jennifer Blythe and her family – including three children – are covered by Medicaid.

She said she has experienced problems finding doctors who accept Medicaid and will provide the same level of care as someone who is not on Medicaid.

Blythe has a seizure disorder and her doctor is not properly reimbursed for her care, which leads her to have less frequent care.

“When the neurologist has to do an EEG scan for me, he gets reimbursed $6,” she said. “For that EEG scan, that doesn't even cover the cost of electricity to run the machine, let alone paying somebody to administer it, the electrodes that are disposable that have to go on your head, the doctor's time and reading the results, etc. $6 doesn't cover any of that, but that's all he gets paid. So instead of doing a scan annually, he will only do a scan every four years for me.”

Blythe said Medicaid also comes with specific requirements that make getting proper prescriptions more difficult. Blythe said she was once written a prescription for insulin, but because syringes were not specified in the prescription, she had trouble getting the supplies she needed from the pharmacy.

“[The pharmacy said] the doctor has to write a separate, distinct prescription just because you're on Medicaid,” she said. “If you weren't on Medicaid and your doctor wrote the prescription for the insulin, the syringes would come with it. But because it's Medicaid, you have to have a separate prescription for the syringes.”

Blythe said this has also affected her daughter who has club feet – a condition that causes feet to be twisted out of shape and can lead to joint and foot pain.

She said if she had not been on Medicaid, she believes this could have been caught and corrected sooner.

“She's going to have to live with this the rest of her entire life because it cannot be fixed, because the doctors would not get paid enough to spend the time to actually do what they needed to do to diagnose her properly and treat her,” Blythe said.

READ MORE: Providers flag concerns about Medicaid infrastructure as ‘unwinding’ disenrolls thousands

Join the conversation and sign up for the Indiana Two-Way. Text "Indiana" to 73224. Your comments and questions in response to our weekly text help us find the answers you need on statewide issues.

The condition is often curable in infants or children at younger ages.

“If we had diagnosed this earlier, we could have gotten her into braces for her legs,” Blythe said. “That would have fixed it if she'd been diagnosed at 2 or 3 or even 6 years old.”

Blythe said a doctor finally recognized and diagnosed the club feet later in her daughter’s life. The doctor recommended orthotics and these reduced Blythe’s daughter's pain significantly. However, Blythe said the issues with Medicaid reimbursement continued.

“They wouldn't cover it because she's not missing part of her foot,” she said. “So they will not cover the orthotics.”

Blythe’s doctor created a payment plan for the shoes – which was out of the family’s budget. She said she is “frustrated” that children are left without access to proper care within the Medicaid system.

“Children should not be paying for their parent's disabilities and lack of income,” she said.

 

 

 

 

View this post on Instagram

 

 

 

 

 

 

 

 

 

 

 

A post shared by WFYI (@wfyi_indy)

 

In addition to these systematic flaws, Blythe said she is “concerned” for the thousands of Hoosiers that are losing their Medicaid coverage during the Medicaid unwinding after the end of the federal public health emergency.

“The unwinding is going to hurt people because they're not going to have any kind of health insurance,” she said.

Blythe said some health care is better than none – but that the Medicaid system is far from perfect.

Providers have expressed similar concerns about Medicaid – including difficulty with reimbursement, leading to their inability to provide the Medicaid services they may want to.

Violet is our daily news reporter. Contact her at vcomberwilen@wfyi.org or follow her on Twitter at @ComberWilen.

Copyright 2023 IPB News. To see more, visit IPB News.