A Phone Call With A Medicaid Case Worker


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This particular post highlights a specific telephone encounter I had a few days ago with my Medicaid case worker.  Read on it’s own, it should frustrate you, but if you read it after my article, “I Had Not Idea How Much Medicaid Would Cost me,” published Monday by The Establishment, it will probably infuriate you even more—as it did me.

A few days ago I called my Social Services case worker because documents to renew my Medicaid, which were supposed to arrive last month, still had not arrived.  Surprisingly, she answered (normally I leave a message and have to wait for a call back).

I let her know, in a professional and in-charge manner, why I was phoning, because often the people who work at Social Services are accustomed to treating their clients as sub-human idiots who are almost certainly at fault for whatever issue they’re experiencing.

She listened to my question and then began checking to find out why my documents for my Medicaid review and renewal had not been sent out.  After a few moments, she informed me that the reason was due to the type of plan I was on.  She told me when I applied I did not check the box stating that I wanted to participate in the “Plan First” Medicaid program, which covers women’s health.  Therefore, I would have to entirely reapply for Medicaid—which meant jumping through all the hoops I jumped through less than a year ago.

Her response confused me for several reasons.  1. When we’d spoken the month before, she’d told me I would receive my renewal paperwork shortly and had made no mention of an entirely new application process; 2. at my last six month review, which included an expected, brief coverage lapse while they verified my spenddown, my policy was reinstated without any issues; 3. I couldn’t figure out why I would ever have checked “no” to Plan First, or, for that matter, how the capable Medicaid personnel who assisted me at my treatment facility would have missed that detail if that particular box was critical for me to continue qualifying for healthcare during my stem cell transplant treatment and recovery.

When I responded saying as much, she simply quipped, “That’s the best I can do,” that I needed to check “yes” for “Plan First” on my entirely new application when completing it, and was then about to hang up on me.  I quickly spoke up, “I am a stem cell transplant recovery patient, and I worked with the hospital’s Medicaid office last year to ensure I got all of this taken care of in order to save my life.”  I added that it made no sense why I would have failed to check “yes” to women’s healthcare, especially if it was key to my receiving Medicaid.

She reluctantly started digging further into the computer system when suddenly she commented that she could see where I had checked “yes” next to “Plan First” (ironically, a minute later I absentmindedly took out a letter from a pile of mail, and it contained my “Plan First” card).  After a little more research, she mused, confusedly trailing off, “I don’t understand why…”  She started to blame their new system overhaul for the reason the mistakes were made—after initially trying to blame me for not filling out something properly (since the client is always at fault, and the system is always right).  She added that she was “very glad” I had called in.

At the end of the conversation, after she’d informed me what to expect in the mail, I took another stand for myself letting her know that I was very aware that she’d tried to pin their/her mistakes on me, and, if I had not spoken up, Social Services would have put me through an entirely unnecessary and stressful process because their system failed and she, assuming it was my error, wasn’t going to investigate further.

The system is flawed, and the people who work in it are so cynical and jaded that, if you are going to makes heads or tails of it, you have to know what you are doing—or at the very least you have to stand up for yourself when they start to bulldoze over you and demand they do their part.  The worst element is, the system is so complex and confusing that even the people who work in it don’t always understand it, which results in people falling through the cracks and not receiving adequate (or any) assistance.  Also, it’s drastically underfunded for the needs of the people it has to meet.

I add this only because mid-terms are next week: please, please consider Medicaid and other welfare programs when you vote.  Don’t believe that cutting funding to these programs will solve the national debt.  By helping people live, access healthcare, and get back on their feet (I’d bet money most people don’t want to receive government assistance), we are doing so much more for the greater good of our country than by taking money away from these programs and the people who need them.  Plus, you never know, you might need one of these programs one day.

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