'Spend-down' ups worries

Medicaid change impacts benefits for elderly, disabled

SIKESTON - A Medicaid change scheduled to take effect Oct. 1 has area recipients distressed over how they will make ends meet.

The big change is the "spend-down." Instead of the recipients just having to show they incurred medical bills equaling an amount to become eligible, the recipients will actually have to spend that much money to become eligible for aid from Medicaid.

The change will save about $16.5 million for Missouri's $18.9 billion budget.

Opponents of the change have predicted devastating effects on the elderly and disabled. The change will affect nearly 25,000 people in Missouri.

"I'm in your middle age group here," said a 56-year-old resident of Caruthersville who spoke on the condition of anonymity. "I've been disabled for 32 years."

She draws workers compensation from the U.S. Department of Labor having become disabled while employed on an air base "I've got osteoarthritis so it's eating me up," she said. Both of her knees have been replaced - one four times. In addition to arthritis, she also has nerve damage and suffers from depression - which isn't helped any by the impending Medicaid change.

"Either you pay your bills and don't go to the doctor or you go to the doctor and don't get your bills paid," she said.

As it is now, private insurance is counted toward the spend-down, she explained, and her workman's compensation is counted as a private insurance.

Of her $1,902 spend-down for a three month period, a total of about $200-$300 for the three months came out of her disability income.

Oct. 1 that will change. "Now, $634 is how much I'm going to have to spend before I get any help from Medicaid," she said.

With a fixed monthly income of $1,106, spending down the $634 only leaves her $472 to pay $800 of bills with, not including food.

"If I had never worked a day in my life, I would be eligible for SSI and all this would be covered," she said. "But because I worked, that's the reason I have the spend-down. It promotes people not working. It doesn't seem to make any sense."

Spend-down recipient Jan McCrillis, 46, of Bragg City, receives $796 income from disability. "That's my total income," she said.

Having worked for 25 years, McCrillis feel fortunate because her home and car are paid for.

McCrillis said she was never on disability until about three years ago when she developed internal organ complications and post traumatic stress syndrome.

Being on a fixed income McCrillis has lived modestly since then but has been able to pay her bills and has not had to worry about her medications.

Required to show she incurred $223 per month for the three month period, she was able to show that amount on the first day by filling her prescriptions for three months. With 25 pills to take each day, the cost of her medication exceeds her income. "My whole problem is prescriptions, its not the hospitalizations," said McCrillis.

With the co-pay on the medication, her total out-of-pocket expense was under $20 for the whole three months.

Starting Oct. 1, she will have to actually pay $223 in medical bills out of her pocket each month before she is eligible for any Medicaid assistance at all.

Additionally, because it is now monthly instead of quarterly, she will have to pay the $20 co-pay on medication three times as often.

"I know there are people who abused the system, but I worked all my life," McCrillis said. "I don't want to abuse the system, I just want to keep living."

Citing "budget challenges," Gov. Bob Holden's spokesman Mary Still recently was quoted by the Associated Press as saying: "There's no opportunity to fund anything extra at this point."

Department of Family Services officials contacted for this story advised they were instructed not to discuss the matter with media.

Some of the information for this story was supplied by the Associated Press.