Guest Post Part 2: Saving Money at the Expense of Patients: The Frightening Realities of Medicaid Managed Care

We are very pleased once again to have Erica Rothschild, Community Organizer at the Gay Men’s Health Crisis, appear as a guest blogger today. This is part 2 of 2 in Rothschild’s efforts to show how taking the prescribing authority away from doctors has a devastating impact on patients. In Rothschild’s last post, she discussed “Max’s” struggles with the new Medicaid policy. Today, she describes “Maria’s” story.

Max is not alone in his struggles.

“Maria” works as an HIV Outreach Educator. As a person living with HIV, she decided it was her responsibility to educate people about HIV, harm reduction, PREP, medication adherence and other important issues. She has been working part time and was considering getting off of SSI and work full time. Obviously a weighty decision for an HIV positive person, but she decided she felt well enough to try.

That began to change October 2012. Maria was denied some medications like B-6 and magnesium that assist her bone strength, liver and kidney. She can feel the difference without these medications; she has increasing bone pain, back pain and is constantly fatigued. She was also denied the patches for her Arthritis that she has been using since she was diagnosed with it five years ago. She says her day to day experience is now painful and depressing.

She spoke with her doctor to restore the coverage for these medications, knowing she needs them to functionally operate the way she has been for the past 5 years. Maria’s doctor plainly looked at her and said “I can write a prescription, but your insurance no longer covers it.” Working part time and living partially on public benefits, she cannot afford the $200 Arthritis medication and has continued living her life without it, but at a cost.

With sadness in her eyes, Maria explains that her job supports her emotionally and financially. She was thinking of working full time and getting off of SSI altogether, but now with these drug issues she is thinking of quitting. “This is my biggest stress of the moment. I never thought about quitting before, but I have to listen to my body. I don’t want to walk away, but if that is what my body is telling me, what can I do?”

This change is unacceptable and puts those with chronic health conditions in jeopardy in a whole host of ways.  Could the re-designers of this Medicaid have blatantly ignored the potentially catastrophic impact of these changes?  Could the bottom line have blinded them so?

The job of all of us who understand this issue, who work with clients and hear these stories, simply cannot wait idly by.  We must spread the word, make the issue clear and simple for those people of influence who can wake up, smell the coffee and make changes that put the client and her physician back in the driver seat where they both belong.

-Jaime Venditti, 3/4/13