Casey Godinez, a care coordinator with Thrive Allen County, didn’t know much about the “Medicaid coverage gap.”
Then she met those who fell into it.
“You shake your head because it just doesn’t make sense,” she said.
The gap refers to those too poor to qualify for assistance through the Affordable Care Act, yet too “rich” to qualify for Medicaid.
The gap is a problem in just 11 states, including Kansas, that have not expanded Medicaid. Though their income falls below the federal poverty line, these people don’t qualify for Medicaid, the state’s health insurance program for the indigent. In Kansas, a family of three cannot earn more than $8,344 to receive Medicaid. (Adults without dependent children do not qualify at all.)
That extremely low ceiling makes them ineligible to qualify for subsidies through the ACA, which begin when a family of three makes at least $21,960 a year. The idea was that states would expand Medicaid to cover that gap. Kansas has not, affecting about 44,000 adults.
Godinez had heard about the coverage gap. She listened to health care professionals speak passionately about it. But it wasn’t until she started working for Thrive that she came to understand — and share — their passion.
“There are real people on the other side of your desk, and a tiny change in their situation can put them in that gap,” she said. “These are people who are working. The numbers just don’t work out.”
It could be something as simple as a change in income or employment. Or maybe the size of their family changed. Maybe a spouse has insurance through work, but the other person doesn’t qualify.
“The look on their face is so hopeless,” she said.
Thrive staff do what they can to help. They explain the situation. They look for other programs the family might qualify for. They direct them to local health care providers that offer a sliding fee scale.
“We want them to feel like they have something. That there is some hope,” Godinez said.
Greta Ingle, a longtime navigator with Thrive, has faced that situation again and again.
It never gets easier.
“My very first client this year cried when I told her she was in the gap,” Ingle said. “It’s devastating.”
