$10 an hour? Try $8 an hour while caring for a family that the government refuses to recognize.

[Lyric]

That's what my partner and I will be faced with shortly. As soon as all of this starts, I'll be able to let you all know firsthand what the experience is like for a truly poor family--except that since nobody wants to "push" for GLBT equality right now, we'll be a family living under the rules for a single person with no dependents.

My partner and I have a soon-to-be-ten year old son. She's 43, I'm 30, and we're both full-time college students. I go to school and then stay home in the evenings with our son (because childcare would cost about as much as I'd make at the jobs available around here anyway.) Rhythm goes to school during the day, then works evenings as a cook in a local pub for $8.00 an hour. It was the best job she could find that is walkable, because we don't have a car and the bus service in the evenings around here is not adequate for anything better. It's part-time; on a good week, she might get 25 hours.

We live as a married couple with a child--a family--but the government considers us to be two single people, one of whom has a dependent, while the other (legally) does not. Our son and I receive Medicaid (for now) because the government considers my school attendance to be a "good enough" excuse for not having a job right now, although as soon as my son is considered old enough to be home by himself in the evenings, that will change. Rhythm has no health insurance at all. She hasn't seen a doctor in years, even though her eyesight is diminishing and she has an acute family history of diabetes and rheumatoid arthritis. I live in terror that the diabetes and the eyesight problems are related, but we have no way to know for sure right now, and no way to DO anything about it even if we DID know.

Rhythm is not eligible for Medicaid because she's physically capable of working and does not have any *legal* dependents. We know this, because we've already tried applying for it (and my thanks to Midlodemocrat for doing her best to help us, even though it didn't work out.) She was denied. I've heard that the new rules raise the income qualification level, which is great, but thanks to the 1996 PRWORA Act (welfare reform), each state gets to decide its OWN qualification rules. The federal government's guidelines are not universally adhered to, nor do they need to be thanks to that act. On a side note, if Obama REALLY wants to make a difference for the poor, overturning PRWORA would be the most effective, humane thing that he could ever, ever do.

Anyway--here's what West Virginia has decided about who they consider "qualified" for Medicaid:

Determining Eligibility for Medicaid

Except in the case of pregnant women and children up to age 19 years, eligibility for Medicaid is based on categorical relatedness, income and assets.

Categorical relatedness means that an applicant must be a member of a family with a child who is deprived of support due to the absence, incapacity or unemployment of a parent(s). If the applicant has no children under age 18, the individual must be age 65 or over, blind or disabled.

The second factor considered is an applicant's income and assets. Income is any money a family or individual receives such as wages, pensions, retirement benefits or support payments. Assets include money in the bank, property other than the homestead, and the cash or loan value of certain life insurance.

When applying for Medicaid, you will be asked about your income and assets you own. DHHR staff will inform you of any documentation needed at the time of your application.

The eligibility of pregnant women and children up to age 19 for Medicaid is determined solely on income. There is no asset test. Pregnant women must provide a medical statement confirming pregnancy.

http://www.wvdhhr.org/bms/oMedPolicyCor/bms_hcpc_Guide_to_Medicaid.htm#Determining%20Eligibility%20for%20Medicaid

Since the law doesn't recognize Rhythm as part of a family with a child (even though she IS), and since she isn't blind, disabled, or over 65...she's not eligible, no matter HOW low her income is. So Medicaid is not a possibility. When the time comes that Rhythm is forced to buy health insurance through the exchange, she will receive a subsidy in an amount meant for a single, able-bodied adult with no children--in other words, $1,384 for an entire year. (I got that number here: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7941841. I assure you, she is not eligible for any kind of "family" rate.)

Her income is about $800 a month. Hers is the ONLY income we have, for reasons I explained above. We get a little extra in financial aid to help out, but not very much--it's enough to pay most of the rent every month. We have a boarder in our third bedroom who pays the rest of the rent for this place. Rhythm's income pays all utilities, a third of the groceries (my Food Stamps take care of the other 2/3's) and all of the household item expenses (like toilet paper and soap--not stuff we can just stop buying.) That's it. We have no savings, no expendable income, and no "extra" money ANYWHERE. If you want to see a family that is LITERALLY living from one paycheck to another with nothing else to spare, well, welcome to my world.

So how are we going to afford an extra $219 a month for her health insurance? The short answer is that we CAN'T, so she'll have to apply for the hardship exemption--and if we're lucky, she'll get it. Which will leave her with no health care at all. Just the same as now. If the other "proud liberals" in this country could be bothered to put forth HALF of the money, time, and internet "activism" toward GLBT equality as they do toward forcing this bill through, maybe it would be different. Maybe the higher subsidy for someone who's taking care of a legally-recognized FAMILY would be enough to offset our actual costs, and she could have healthcare--even if only a crappy policy that covers little and has a huge deductible. Half a loaf is better than none at all, right?

Well not for us, because Rhythm's getting nothing whether the bill passes or not. All we can expect is the addition of some more red tape, made necessary because she'll have to prove that she's too poor to afford insurance. And IF the government decides that Rhythm appears to be capable of affording her premium "on paper" (where our family doesn't exist and therefore doesn't matter), she'll get rejected for the hardship exemption and end up forking over money to the IRS. I think she'll be approved for it, but you'll have to forgive me if I'm more than a little bitter about the fact that the BEST my beloved partner can hope for is that she WON'T get smacked by the IRS.

And other members of my family are screwed too, just in different ways. We're all poor, and this is going to hurt every single one of us with the exception of my dying Mom, who was approved for disability Medicaid today (thank god) although there's some red tape that might hurt us there, too. I really wish people would stop pretending like this bill is meant to help the poor. It isn't. It's meant to help certain select elements of the middle class, and a few poor people who meet strict guidelines and live in compassionate states with lenient Medicaid qualification rules MIGHT benefit too. Just as many (if not more) poor people stand a fair chance of getting nothing at all at best, or royally screwed at worst. GLBT and certain hetero couples (unmarried, cohabitating, with kids that are only the "legal dependents" of ONE partner) are getting the worst deal of all.

So I guess we'll just keep using the emergency room as the only healthcare available to us, and hope like hell that maybe SOMEDAY everyone else who's supposedly on "our" side will find it politically expedient to actually fight (which means RISKING something) for the equality and social justice that this nation SORELY lacks. I won't be holding my breath, but I suppose it's theoretically possible--IF we can elect some leaders who care more about doing the right thing NOW than about getting re-elected later. And that is probably the biggest and most unlikely IF of all.

[Autumn]

1. I'm so sorry, Lyric.

Everything you are going through is so fucking wrong. It isn't supposed to be this way.:hug:

[sandnsea]

3. Her partner will finally get health coverage

Adults will be qualified for Medicaid without kids, when this bill passes. At least that part of her life will be fixed.

[Lyric]

6. You keep saying this.

I've seen nothing whatsoever to indicate that this is true. If you have a link, by all means, share it. This is one area in which I'd be glad to be proven wrong.

Edit: And even if the federal bill DOES allow Medicaid for adults with no children, does it overturn the provision of PRWORA that gives states the right to set stricter limits than the federal government? Because if it doesn't, then the federal guidelines don't necessarily mean that STATES will permit adults with no kids to receive Medicaid.

[sandnsea]

9. Here

That's what that whole fight with Nelson was about, he was arguing that states couldn't afford the mandated expansion to all adults up to 133% of poverty. Afaik, he has still lost.

http://www.ama-assn.org/amednews/2009/09/28/gvsb0928.htm

[Emit]

44. Expansion of Public Programs under The Patient Protection and Affordable Care Act (Senate Bill)

Expansion of Public Programs
Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009). This expansion will create a uniform minimum Medicaid eligibility threshold across states and will eliminate a current limitation of the program that prohibits most adults without dependent children from enrolling in the program today. Eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) for children will continue at their current eligibility levels until 2019. People with incomes above 133% of the poverty level will obtain coverage through the newly created state health insurance Exchanges.

�� The federal government will provide 100% federal funding for the costs of those who become newly eligible for Medicaid for three years (2014‐2016). In 2017 and 2018, states will receive an increase in the federal medical assistance percentage (FMAP) based on current state eligibility levels for adults, and then beginning in 2019, all states will receive the same FMAP increase. Different funding rules apply for Nebraska and certain states that are not eligible for the increased FMAP because they have already expanded Medicaid eligibility.

http://www.kff.org/healthreform/upload/8052.pdf

For a side-by-side comparison of the Senate and House Bills on this subject, see: http://www.kff.org/healthreform/sidebyside.cfm

You need to check the boxes for both the Senate and House Bills, then select the "Expansion of public programs" box to get the details:

House:

Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 150% FPL. Provide Medicaid coverage for all newborns who lack acceptable coverage and provide optional Medicaid coverage to low-income HIV-infected individuals (with enhanced matching funds) until 2013 and for family planning services to certain low-income women. In addition, increase Medicaid payment rates for primary care providers to 100% of Medicare rates by 2012. Require states to submit a state plan amendment specifying the payment rates to be paid under the state’s Medicaid program. The coverage expansions (except the optional expansions) and the enhanced provider payments will be financed with 100% federal financing through 2014 and 91% federal financing beginning in year 2015. (Effective January 1, 2013)

Senate:

Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (MAGI). All newly eligible adults will be guaranteed a benchmark benefit package that at least provides the essential health benefits. To finance the coverage for the newly eligible (those who were not previously eligible for a full benchmark benefit package or who were eligible for a capped program but were not enrolled), states will receive 100% federal funding for 2014 through 2016. Beginning in 2017, financing for the newly eligible will be shared between the states and the federal government through an increase in the federal medical assistance percentage (FMAP). For states that already cover adults with incomes at or above 100% FPL, the percentage point increase in the FMAP will be 30.3 in 2017 and 31.3 in 2018. For all other states, the percentage point increase in the FMAP will be 34.3 in 2017 and 33.3 in 2018, except Nebraska, which will continue receiving 100% federal funding for newly eligibles after 2017. Beginning in 2019, all states will receive an FMAP increase of 32.3 percentage points for the newly eligible. The increased FMAP for all states, except Nebraska, will be capped at 95%. Certain states not eligible for the enhanced federal funding because they had already expanded Medicaid to adults with incomes above 133% FPL will receive a 2.2 percentage point increase in their FMAP for parents and childless adults who are not newly eligible for 2014 through 2019 or a .5 percentage point increase in the FMAP for 2014 through 2016. (Effective January 1, 2014)

Here is a calculator, whereby, when I input the data of your SO, (age, dependent status, annual income based on $8 x 25 hours per week = $10,400/year) it indicates she would be Medicaid eligible: http://healthreform.kff.org/SubsidyCalculator.aspx


In addition, here is the 2009 POVERTY LEVEL GUIDELINES for ALL STATES (EXCEPT ALASKA AND HAWAII) AND DC, Income Guidelines as Published in the Federal Register on January 23, 2009 Annual and Monthly:

Here:
http://www.dhhs.state.nh.us/NR/rdonlyres/e7xgivwj7zrojopvtjh4rfgmf7ablliwx7gbzalbbrb2mnkkyfqxrpjnzjm6a2v5e3ioyqrmc6fdz5vceaf2jwn2kqe/Fed+Poverty+Guidelines+2009+Annual-Monthly.pdf

or Here:

http://docs.google.com/viewer?url=www.azdhs.gov%2Fphs%2Fhiv%2Fpdf%2Fadap%2FFHCE_FedPovertyLevel.pdf


Of course, this is just an estimate, based on interpretation of the proposed bill(s), as they stand now. You are right to be concerned about how each individual state will deal with the details if something passes. There are many hoops and hurdles involved with qualifying for Medicaid, as you undoubtedly know, and each state gets to tweak those a bit.

[Autumn]

10. That remains to be seen. As I understand it.

the states set the guideline as to who qualifies for Medicaid. But we will soon see.

[sandnsea]

11. They won't if this passes

They will be mandated to provide coverage to adults up to 133% of poverty. See my link above. That's what states have been freaking out about for months now.

[1776Forever]

19. Wow that is great news! I hadn't heard that - it will help a lot of people when that happens!

My son got MS when he was 38 and we had to wait 2 years to get his SSI through. We helped him the best we could but it took a lot of our resources because he was in such bad shape and he couldn't get any help in Florida for him. I hope that this family and others can get the health care they need soon! I hope it doesn't take 4 years to go into effect!

[sandnsea]

2. That OP is wrong

Try this calculator. And, again, these bills are all changing Medicaid so adults will qualify.

http://healthreform.kff.org/SubsidyCalculator.aspx

[Lyric]

5. Adults DO qualify.

But I assure you, states ARE allowed to set their own qualifications too, thanks to PRWORA. Those qualifications can be MORE strict than the federal government's rules, but not less. So far as I understand it, the "new changes" are all about income qualifications. Rhythm ALREADY qualifies based solely on her income. She's only disqualified because she has no dependents.

But please, ignore my official State of West Virginia link that proves my point and call yourself. I don't know what state you live in, but if it's a red state, there's a good chance that adults there have to be part of a family with either a child or some other kind of "dependent" person in order to get Medicaid. If not, try another state. I'm not a social worker and I don't know EVERY state's rules, but I damned sure know OURS.

[Schema Thing]

20. why would the state of WV have up provisions of a Federal Law

that hasn't passed yet?

[jeff47]

29. PRWORA passed in the 90s.

While this bill makes it possible, PRWORA allows states to disqualify adults.

[Schema Thing]

33. I would guess that this bill either explicitly prevents that, or

makes it so that states are ineligible for the new additional federal funding if they do so.

[jeff47]

34. Why would it?

PRWORA is a fantastic thing if you ask the moderate Democrats. Why would they undermine it? They'd just tell you to move to a bluer state.

[Schema Thing]

37. I can only go by what I've heard so far

It *seems* to be being presented as an across the board access to Medicaid for 133% and down.


Maybe they are hiding the reality, but I think I would have heard about that by now, if so.

We'll see.

[jeff47]

38. There are 2 levels of access

First, the federal government has to say "you can offer these people Medicaid".

Second, the state has to actually offer Medicaid to them.

The HCR bill takes care of the first part. And in the blue states, we can expect the state rules to be changed shortly. But they're not all blue states.

Disclaimer: I haven't had time to pour over the bill myself.

[Schema Thing]

39. And the HCR may well take care of the second part

It seems likely to me that it does, at the least through funding availability if not through law. Apparently it seems unlikely to other people.

[laughingliberal]

42. The governor of my state is proposing we opt out of Medicaid altogether

Trust me. There are a lot of poor American adults who will not get the help they are being told they will.

[Schema Thing]

21. .

[tnlefty]

4. I'm so sorry.

I've been stating as often as I can that my family was damned near bankrupted by BCBS, a union negotiated plan that we'll be taxed for, and my kids and I don't get physicals as they're not covered.

I just wanted better for everyone in this country. :hug:

[nadinbrzezinski]

7. There are many things I hate about this country

chiefly how we are going BACKWARDS in so many things...

In the long run though, re healhcare, given how much the SS and Medicare bills sucked... yes they should get incrementally better... that is US History... not that this is any comfort right now.

[eridani]

46. The opening for SS and Medcare to get better was that they were GOVERNMENTprograms

--not mandates to buy a private product.

[madrchsod]

8. this should`t happen in the america...but it does

we are sold to the highest bidder.

[rcrush]

12. I just got medicaid approved for my dads nursing home care

That sucked. My dad had to pretty much lose everything just so Medicaid would pay HALF of the nursing home bill. My dad has to give up all his retirement from civil service, air force, and social security and medicaid covers the rest. And they check his bank account every month to make sure he doesnt get too much money in there or they will kick him off medicaid.

He used to be middle class he isnt anymore.


I know its not the same thing but I dont think theres anything in the new bill to help the elderly and their nursing home needs. Not that I ever expected there to be any.

[sandnsea]

13. Actually there is

The CLASS Act. I really don't know that much about it, but it's there. Maybe you'll want to read through it and share what you find out.

http://www.kff.org/healthreform/kcmu102009pkg.cfm

[laughingliberal]

43. I hear you. My patients had to spend down to within $2000 in assets in order to get Medicaid. nt

[awoke_in_2003]

14. All of this sucks...

the way we define a married couple or family unit, the state of health care in this country, and the state of wages. It all blows, and we are being pushed closer to 3rd world standards. Oh, and about the diabetes- almost guarantee that it is affecting the visual. My wife also has diabetes, worsening eyesight, and rheumotoid arthritis. It is so bad that only moderate use of her hands will cause them to lock up in pain. She has pain in both legs, and one them alternates between pain and numbness. Then there is the Sjordens syndrome, and a few other things. She quit work at the end of January because she just cannot do it anymore. All four her doctors say she qualifies for disability, and the appropriate paperwork has been filled out. Of course, they don't believe it and have to examine her themselves at the the end of April- unreal. In the end, though, she should get it along with medicaid (or is is medicare, I can never remember). That will be good- because as bad as medicare may suck, UHC sucks harder. Hang in there.

[troubledamerican]

15. Plus: Now, a Mandate & excise tax. YAY -- WE WON

[Divine Discontent]

16. have my own horror story with so much familia suffering, so I say my greatest so sorry you are havin

to suffer. Best to you my GLBT "cousin".

[Egnever]

17. well thats a pretty horrible story but

$800 a month as an idividual is below the poverty level. As i understand this bill anyone up to 133% of poverty will now be eligable for medicaid. So she should be getting free health care soon.

[readmoreoften]

23. Where the heck did you here that? Eligible for medicare at 133% of the poverty level?

Impossible. That would mean that someone $8 an hour 30 hours a week would not have to pay for health insurance. Haven't heard that anywhere else.

[quakerboy]

47. That does seem to be the state of things

"The Patient Protection and Affordable Care Act expands eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level"

From the Democratic Policy Center
http://dpc.senate.gov/healthreformbill/healthbill45.pdf
First page, Second heading, first check mark

I have also read it in most comprehensive summaries of the bill that I have seen. Even the Heritage foundation takes note of this detail, though their spin is that its a horrible thing to provide this horrible awful entitlement to more of those nasty freeloading poor people. Plus all the poor people that carry health insurance will immediately drop now they can get this, thus reducing the number of right thinking health care free market paying citizens and causing a never ending spiral into government control of our guns and rich peoples money via the unjustice of taxation.

[Hello_Kitty]

28. self-delete. eom

[hfojvt]

18. about the eyesight

http://hubpages.com/hub/Eye-Exam-Coupons

For other medical care is one of these a possibility?

http://www.wvfreeclinics.org/clinics/

[Schema Thing]

22. from politfact (and Nancy Pelosi this morning, for that matter):

Currently, Medicaid is available to low-income individuals who are pregnant, disabled, elderly or have children 18 years old or younger; the program covers about 60 million patients. The Senate and House health care bills, and Obama's latest health care proposal, would open up the program to all people under 65 with a low income. The Obama proposal and the Senate bill would offer Medicaid benefits to those with incomes up to 133 percent of the federal poverty level, while the House version would allow those with incomes up to 150 percent of the federal poverty level to enroll.



Also, money is in there (I don't know how much) for bringing more doctors and providers into participation in Medicaid.

[readmoreoften]

24. Never mind, got it.

[jeff47]

30. The problem is that it only 'opens it up'

It doesn't mandate it, and PRWORA allows states to have more stringent requirements. You can bet that a bunch of "Red States" will "stick it to Obama" by not letting adults qualify.

[southernyankeebelle]

25. Got news for you sister, my son has worked very hard in a restuarant for

several years as a cook. No college degree. Not all people are made to go to college. Now my son pays over $400.00 per month for health care for he and his child. He is divorced from his wife. If it weren't for me and his father I don't know what he would do. He works very hard and doesn't ask for handouts. So yes I know what it is like to make $10.00 per hour. My son has been doing it. His place of business cut their hours back. Last 2 weeks he was lucky to get overtime. They cut their vacation time back. He was suppose to get 2 weeks and now they get 1. .You know many people are in your shoes. My ex-daughter-in-laws mom adopted a baby that was the grandson of her husband (2d marriage). The baby was a drug baby with a whole lot of problems. I mean serious medical problem. Tncare cut him off the program. Her ex husband pays for insurance and now she has been put on nights at work where she doesn't get overtime. Now she is paying for his care to. Talk about problems, everybody knows someone who is experiencing what you are experiencing. My heart goes out to you. Isn't there any help for babysitting you can get from the state?

[Gormy Cuss]

31. That's not news for Lyric.

It's great that your son can get by without handouts from any place but the Bank of Mom & Dad, but not everyone has an account at that bank. That's why government assistance programs are good for closing some of that gap.

[DesertDiamond]

26. I feel the way the word "dependent" is defined needs to be changed altogether

Some of us have had neither marriage nor children, but we have had dependents. Several times I have taken in friends for months at a time because they were unemployed. Once, a whole family because the mom was gong through a divorce and had become dysfunctional. I had to take care of everything. I got no help from anywhere, including no tax break, even though I did indeed have dependents. I thought back then, this whole concept of dependents need to be redefined altogether.

[fairlight]

27. medicaid/medicare discriminate against certain groups

Thanks alot for this post, Lyric. I didn't realize some of this. You are right; this bill is leaving alot of citizens out. Two million seniors over 65 are NOT covered by Medicare; there is a common fallacy in this country that anyone over 65 is covered, not true. If a senior is dirt poor and spends down all their savings they can possibly get medicaid. They won't have enough to live on, nor any cushion against emergency, but hey, they'll have some coverage, though many doctors don't take medicaid patients, or find a way to get the benefits of medicaid without taking many patients. Medicare/medicaid discriminate based on sexual orientation, marital status, employment status and benefits, age, and whether or not one has dependents. To the many people who choose single parenthood, I warn you, the government will not help you with your retirement as they would with a married woman, for example, who is free to be a mother and homemaker as she will get her husband's retirement if she stays married 10 years. A single parent doing the same thing with no help from a mate gets nothing at retirement. This is one of the many problems with this bill. Prisoners get free health care. I would not have it any other way. But why shouldn't the rest of us get health care too. I am willing to pay a fair price for it. But $448a month,(the buy-in amount to get medicare), isn't fair, or affordable. We are all entitled to life under the Constitution, and healthcare is necessary to maintainance of life. People are dying because America is about the last country to have healthcare for all. And brainwashed people are backing up Republican lobbyists for rich interests without realizing what they are really about. They think they are following some republican ideals, but they are dupes of the rich, and they need to wake up. They are causing real suffering and even death.
Fairlight

[laconicsax]

32. Welcome to DU!

[Cherchez la Femme]

35. Well, in this country we're all created equal, ya know

unless you're gay

...then fuck your rights and the hell with your 'family'.

begin :sarcasm: ---Ungrateful bastards--- end:sarcasm:
(Sad I have to add those qualifiers)

[sammytko]

36. doesn't your college provide student health insurance?

my niece if full time. she fractured her kneecap and didn't know she had insurance through her college. the school nurse gave her the info and they paid for her hospitalization (2 nights!) and now therapy.

[ljm2002]

40. If you think she has diabetes...

...get her to a clinic for a diagnosis.

There are things you can do, like dietary adjustments, that can be very helpful even if she does have diabetes. But if she has the Type I kind, she absolutely needs to get treatment. Buy it, beg it, borrow it, but do what you have to do. It cannot be ignored and it will not go away by itself.

I know you already know this. I know you are in a real bind. But you'll be in a much worse one if you don't take this bull by the horns.

That's my advice. And before you get annoyed (which I would not blame you for), please take it as it is intended, as a nudge to do what has to be done even though it seems impossible.

[Tailormyst]

41. Sorry Lyric

I wish I could find some more comforting words.

[SocialistLez]

45. Free clinics?

OP, is there any way you can go to a Free clinic in your area?

I know they may not be TOO much help in terms of meds every month but it's a start.
These websites may be of some help with covering the costs of prescriptions: http://www.pparx.org/
http://www.needymeds.org/

The emergency rooms are a costly way to get medical care. I would TRY to call around for general practitioners and see if they'll see you and you can work some sort of payment plan out. I know some docs are very nice when it comes to letting people pay over time, they know it's rough out there.

I am wishing you the best of luck.
As you can tell from my username, I'm part of the LGBT family and the future worries me. I'm only 19 and I worry about the future for my girlfriend and I. I truly do.