Public Benefits (not) for the Public?

One of my earliest memories with the National Health Corps was during pre-service orientation when all of us were getting a crash course on how to apply for Food Stamps or the Supplemental Nutrition Assistance Program (SNAP).  A few members from a local non-profit came in to help navigate us through the SNAP application process. I understood that the process of applying for public benefits could be frustrating and lengthy but I had no first-hand experience. I think the most humbling part of the process was knowing that a group of intelligent, college-educated adults still needed help navigating the system. It made me wonder how people who don’t have any guidance fare when they navigate the application process themselves. I would soon become aware of many of the challenges the general public faces through patient interactions at my host site, the Birmingham Free Clinic.

According to January 2018 enrollment data from medicaid.gov and the US Food and Drug Administration, about 42 million people are enrolled in SNAP, 67 million in Medicaid, and 55 million in Medicare (Note: 11.7 million people are dual-enrolled in Medicare and Medicaid). At Birmingham, we connect our patients with certified insurance navigators to get them enrolled in insurance — including Medicaid, Medicare, or an Affordable Care Act Marketplace plan. Initially, I didn’t fundamentally understand the idea of insurance navigators; I had naively assumed that public benefits systems would be designed simplistically enough in which the average American would be able to navigate the process themselves. (They are called public benefits so shouldn’t they be designed for the public?) Later, I found through working with insurance navigators, that the process of becoming a registered navigator takes approximately a year and involves attending several trainings and taking certification exams. As I spoke with more patients about their experiences applying for SNAP and Medical Assistance, I gained a much clearer picture of what the reality of applying for public benefits looked like.

Over my seven months at Birmingham, there have been several cases where the complexity of the American public healthcare system is brought into perspective. One patient who stands out among those at Birmingham who are navigating the system is Jim. Jim is a middle-aged male with several chronic health problems, depression, and a rare autoimmune condition that affects his kidneys. From the beginning, Jim was frustrated with his health status and the difficult series of interactions he had with the public benefits system. He first came to Birmingham early in 2017 having been denied disability benefits and Medicaid because the joint income between him and his wife was too high. Jim noted feeling frustrated and burdensome to his family, because he could only work part time and couldn’t provide for them. After his first couple of visits, we referred him to one of our insurance navigators to start a Medical Assistance for Workers with Disabilities (MAWD) application. His first MAWD application took two months of waiting and several phone calls with the county assistance office, only to be denied. Jim and the insurance navigator started the appeal process, but it felt like each time his application was deemed ‘complete’ by the county assistance office, he had to jump through another hoop in the form of getting more documents. Overall, Jim remained discouraged with the public benefits system and struggled with adjusting to his ‘new normal’ of being uninsured with several health problems. After six months, we got news that his application was finally accepted. Scenarios like Jim’s bring into focus all of the social, mental, and physical factors that make up one’s health and how having to repeatedly validate your need for public benefits can be a demoralizing process. I am grateful to have gained a better understanding of the public benefits and healthcare system through cases like Jim’s. Ultimately, I believe the application process for public benefits needs adjustments that allow it to be more accessible and navigable for the general public; but for now I am thankful that Birmingham affords patients much-needed access to insurance navigators.

Sources: medicaid.gov
United States Department of Food and Drug Administration
Kaiser Family Health Foundation
*patient’s name was changed for privacy reasons*

This post was written by NPHC member Lauren Gochenaur.

Lauren serves at Birmingham Free Clinic as a Patient Navigator.