System Riddled With Obstacles

A disabled man obtains a job: A 28-year-old, chronically ill man with schizoaffective disorder who receives Supplemental Security Income and treatment, including vocational rehabilitation, through Medicaid improves and secures a paying job. As a result of this income, he loses Medicaid coverage, which pays for medications as well as supportive and clinical services that enable him to keep his job. His employer does not offer a health insurance plan. The loss of Medicaid and its specialized services jeopardizes his recovery and employment.

A woman on Medicare exceeds the threshold for Medicaid eligibility: A hospitalized woman with chronic schizophrenic illness who receives Social Security Disability Insurance and Medicare benefits is not eligible for Medicaid because she is slightly over the income level and owns a home. She cannot be placed in a nursing home without Medicaid, so her hospital stay is unnecessarily prolonged. She cannot obtain medications, transportation to treatment, and long-term home health care services through Medicare. She probably will not use these services since she would have to pay for them herself.

A young man transitions out of his family: A 19-year-old single man with substance abuse problems and an adjustment disorder is no longer eligible for his family's employer-based health insurance. He is ineligible for entitlements, such as Medicaid, because he lives with his parents, and their income is too high. If he lived alone, he would be eligible but would lose the support and stability his family provides. If he qualified for Medicaid, his benefits would be administered by a managed Medicaid program that offers no access to case-management services. Those services would be essential for him to receive vocational rehabilitation and access to housing.