Fraze, a single mother, said she was making about $12,000 a year and receiving about $650 a month in child support. But last year, the state said she was making too much money to keep the children’s Medicaid coverage.
Get insurance through her employer? Fraze, who has always worked in the service industry, doesn’t get those kinds of jobs. Pay for care out of pocket? Not a chance — her 16-year-old son Dustin racks up about $1,400 a month in medications for allergies and asthma so severe he has been hospitalized several times. The shots he gets are costlier, one of them $4,300 per injection.
“I want to work,” said Fraze, 38. “But basically I’m in this situation.”
So she made her calculation. Dustin and his 13-year-old sister Morgan can get Medicaid coverage as long as the annual household income remains under $19,000, the cut-off for children in a family of three in Florida. She said there’s a safety net program for Dustin since he requires so much care but her daughter would have nothing if the family lost Medicaid.
Every week, Dustin has to sign in at All Children’s Hospital Outpatient Care Center, immediately head for an exam room — he could have an allergic reaction sitting in the carpeted waiting room — and roll up his sleeve for allergy shots or injections of his expensive asthma medication, Xolair.
His mother said the services covered by Medicaid have kept Dustin alive since he first began having reactions at age 2. “If it wasn’t for Medicaid,” Fraze said, “Dustin wouldn’t be here.”
Fraze counts herself lucky in some regards. She and her children live rent-free in her father’s home. Her boyfriend pays her power bill and car loan. Child support covers the basics for the kids.
But she doesn’t have the health coverage that her children do. Fraze’s income is still too high to receive regular Medicaid for herself. Because she’s poor but not poor enough, the state enrolled her in Florida’s Medically Needy Program, which functions like an emergency Medicaid program.
Depending on their income, these patients owe a certain amount of money before Medicaid kicks in. When Fraze was working, her share of medical costs was as high as $700, she said. Now, it’s $7.
The program can be a huge help, such as when Fraze had to have a hysterectomy last year.
But she said finding a doctor who’ll take Medicaid cost-share patients is even harder than finding ones who’ll take regular Medicaid. Without a regular primary care physician, her option is also the most expensive one — the hospital emergency room.
That’s where she ended up last weekend after breaking her ankle while playing basketball with her daughter.
Times researcher John Martin contributed to this report.
Jodie Tillman Tampa Bay Times
A nurse Saving children
Erika Vila, a nurse at Miami Children’s Hospital, says expanding Medicaid in Florida means she might see more of her young patients grow up to have children of their own.
That’s her hope as nursing director of the hospital’s cardiac program, where patients range from premature babies to adults. Those with the most serious heart defects usually wind up in the high-risk clinic, where many, mostly children, rely exclusively on Medicaid to pay for multiple surgeries and round-the-clock specialized care.