While the battle over the future of healthcare wages on Capitol Hill, some Americans are fighting for affordable coverage right now from home.
The WUSA9 Special Assignment Unit (SAU) met one woman who falls into a gap in the healthcare system.
Andraea LaVant lives in Hyattsville, Md. with a form of muscular dystrophy called spinal muscular atrophy. The effect is muscle weakness.
“I go to work every day and people have no idea what it takes for me to get there,” said LaVant, during an interview at her home in June.
“I literally cannot get out of bed,” she said.
That was clear when the SAU visited her home one morning before she left for her full-time job in the city.
Each day, someone must lift her from her bed, prepare her meals and help dress and groom her. The reverse happens each night. The process takes about five hours every day.
“Some people think ‘Oh, it’s an optional thing.’ But for me it’s literally lying in the bed if nobody comes.”
Usually a home nurse or personal care attendant helps LaVant.
Instead, when the SAU arrived, LaVant’s friend, Josie Gilliland, was on duty.
“She can’t reach across the counter to get toothpaste, or, you know, grab things off the shelf,” Gilliland said.
“I have multiple friends who have had to be quickly trained to help me in the morning and at night,” LaVant said.
That’s because for the last ten years, LaVant said the state of Maryland has granted her a Medicaid waiver for her home nursing.
A bill she showed the SAU indicated the cost could run as high as $2,250 per month. LaVant has private insurance through her employer, but she said that coverage doesn’t include daily home care.
An Unexpected Letter
LaVant’s life changed in June when she opened a letter issued by the Maryland Department of Health. Her Medicaid had been canceled.
“I mean, I can’t completely panic, but you’re just kind of trying to like quickly forward think like ‘What could this mean?’” she said.
The notice LaVant showed WUSA9 gave no explanation for cancelation beyond a reference to a section of the Maryland code of regulations.
Further, it gave no remedy for appeal.
“Nobody had any answers for me whatsoever,” LaVant said.
LaVant took her questions to U.S. Senator Chris Van Hollen (D-MD) and to WUSA9.
An aide for Sen. Van Hollen wrote in an email the state canceled LaVant's Medicaid citing financial ineligibility. It means the state realized LaVant makes too much money to qualify for Medicaid.
The answer raised even more questions. LaVant said her income never changed.
LaVant provided WUSA9 a copy of her 2015 application for Medicaid, which was approved. The document plainly states her monthly income, which was more than the $1,366 per month limit the Prince George’s County Department of Social Services said she must fall below to qualify. PGCDSS is the local division for the Maryland Department of Human Services.
“I would love to say that my income has increased so much,” she said. “But there’s nothing in my day-to-day or in my condition or anything like that, that has changed.”
LaVant added that she had been denied Medicaid coverage in the past, but was ultimately approved. "I would have to go to social services and say 'I don't know what I'm in, but I've always had Medicaid.' And it would magically -- I don't know what they would do."
After WUSA9 started making calls, the Prince George’s County Department of Social Services, a state-run agency that oversees her Medicaid program, opened up a bit.
On July 7, an employee told LaVant over the phone that she would have the opportunity to appeal the state’s decision.
One week after that call on July 14, LaVant received a letter dated July 7 indicating her Medicaid was back in effect through May, 2018.
Six days later, on July 20, LaVant received yet another letter. She had been scheduled for an appeal hearing on August 3. A judge would decide if she qualifies.
State Finds a Mistake
It was only during the hearing that LaVant learned why she had suddenly been cut off.
Steven Simone, an appeals representative for PGCDSS, said the agency made a major mistake.
“The medical assistance was based on zero income,” Simone said, "that was a department error.”
Paperwork Simone provided LaVant prior to the hearing showed the agency coded LaVant for food stamps, which caused her application for Medicaid to be approved. It appeared she made no money.
What’s more, the paperwork doesn’t say when PGCDSS made the mistake. The timeline is important because if it turns out the Maryland Dept. of Health paid for her Medicaid by mistake, the department could send her a bill.
A Hefty Bill
If the state determines she was never entitled to Medicaid, the agency could try to recoup ten years' worth of Medicaid payouts. Based on the bill she showed us, LaVant could be on the hook for hundreds of thousands of dollars.
“I’ve done everything that I’m supposed to do,” LaVant said. “That’s what’s frustrating.”
For now, LaVant should receive the Medicaid benefits – that’s customary while her case is in the appeals process.
The administrative law judge has until early October to decide if LaVant qualifies for Medicaid based on calculating her income, housing costs and medical costs.
LaVant said without a personal care attendant, she will be forced to give up what she loves most.
“Freedom,” she said, "what America is supposed to stand on.”