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  • Dual Eligibles
  • Alicia

    Securing Medicaid Coverage for Seniors: Alicia’s Story

    When 79-year-old Alicia* moved from New Jersey to Pennsylvania in July, Medicare was her only insurance.  But Medicare coverage is not all-inclusive.  Alicia, and millions like her, must cover all or parts of certain medical expenses.  That’s extraordinarily difficult for people on a fixed and low income.  When Alicia lived in New Jersey, had Medicaid covered the difference, but that coverage ended when she moved to Pennsylvania.  Without secondary insurance, Alicia couldn’t afford to get the health care she needed to treat her conditions including anxiety, depression, osteoarthritis, cardiac arrhythmia, and retinal detachment.  She needed to see doctors right away for ongoing care and she required daily medications which she could not afford.  Alicia was forced to make the difficult decision too many are forced to make when they don’t have comprehensive health insurance: either get the health care she needed, or pay for groceries, rent, and utilities.

    Alicia’s case manager from her local Aging office suggested that she apply for Medicaid to help with the costs associated with Medicare, such as the monthly premium as well as cost-sharing left over by Medicare and co-pays for doctor visits and medication refills.  Alicia applied for Medicaid at her local County Assistance Office, but she ran into problems almost immediately.  First, they told her she needed to submit a letter verifying that she was no longer enrolled in NJ Medicaid.  Alicia made multiple attempts to reach the NJ Medicaid office to request such a letter, to no avail.  Next, she was told that her application for Pennsylvania Medicaid would take up to 30 days to be processed even once everything was submitted.  She simply could not wait that long.  She called PHLP for assistance.

    We immediately contacted the County Assistance Office to request that her application be expedited given her urgent medical needs and asked them to lend Alicia assistance verifying the end of her NJ Medicaid coverage.  We helped Alicia get a letter from her doctor back in New Jersey explaining her medical conditions and urgent need for care, which we submitted to the County in support of our request to expedite her application. Within a few days of our outreach to the County, Alicia was approved for Medicaid coverage. She is now able to get the care she needs without worrying about choosing between health care and daily expenses.  Alicia is grateful for PHLP’s help and relieved to have the coverage she needs.

    * Name has been changed