In Tennessee, Tightened Access to Medicaid means Tough Choices

Healthcare is a luxury to some, especially in rural America. Basic medical care is unaffordable to those without adequate health insurance. Casey Britton, a TN resident, filed a 13-page Medicaid application and faxed it to the state before the March 31st deadline, but she received a notice on April 30th informing her that she no longer qualified. This also meant her two young sons, ages 2 and 5, would lose access to medical care.

32 states have expanded Medicaid after passage of the Affordable Care Act, commonly referred to as Obamacare. Virginia just voted to expand coverage, meaning only 17 states have refused to offer additional assistance to low-income individuals.

Tennessee went in the opposite direction and established work requirements for Medicaid recipients. The state follows in the foot steps of Indiana, Arkansas, and Kentucky. Governor Bill Haslam signed the bill, which requires adults with children under six to work, attend school, or volunteer part-time to continue Medicaid coverage. This is yet another move to restrict access to Medicaid.

Britton notes that qualifying for Medicaid is one hurdle, but accessing care is another. The rural area she lives in doesn’t have a pediatrician, meaning she has to drive 60 miles or use a walk-in clinic for her and her family’s healthcare needs. She takes care of her young children while her husband works in Nashville. She anticipates having more free time to find a job with her kids in school, but opportunities are limited where she lives.

The Trump administration supports work requirements for Medicaid, stating that people who work will get out of poverty and be healthier as a result. Advocates for health care are vehemently opposed and say that the move will lead adults to ignore chronic health conditions, skip preventative care, and result in more visits to the emergency room.

In 2016, 14.1 million children lived in poverty across the country. The percent of children in poverty in rural areas is higher than urban areas, with 24 and 19 percent respectively. The gap increased during the Great Recession and continues to widen, especially for single-parent homes and African-American children. In 2017, nearly 1.5 million children in TN were enrolled in Medicaid.

The Tennesee Justice Center predicts that over 480,000 low-income individuals could lose access to Medicaid under the new work requirements. The Kaiser Family Foundation reported that 60 percent of the 24.6 million Medicaid recipients across the country work at least part-time. Medicaid work requirements are set to go into effect in Indiana, Kentucky, New Hampshire, and Arkansas. There are 1.2 million residents receiving Medicare in Tennessee as of 2015.

Perry County, where Britton resides, has been struck by poverty as businesses re-located along the interstate, reducing job opportunities and growth. The Great Recession hit the county with a 29.8 percent unemployment rate.

It has since recovered and sits at 4.2 percent, but many residents left the area for Memphis or Nashville to get jobs. Jobs that are left pay low and don’t offer benefits such as health insurance. Rural poverty is a serious issue, notes Timothy McBride from the Center for Health Economics and Poverty at Washington University in St. Louis.

Lack of access to healthcare is spurred by the lack of reliable public transportation. Residents rely on friends and family members. Gas costs add up quickly, and fares can be exorbitant for some trips. Britton’s husband drives 90 miles one way to get to work, and getting to school by bus for the children takes an hour.

Policymakers ignore the reality of rural poverty and how these requirements are not compatible with daily living. Parents, such as Britton, go without to ensure their children are taken care of first.

Carlos Lopez is the director for Disabled Friends. He also handles the department of disability resources for MedicareFAQ, a learning resource center for all seniors and Medicare beneficiaries.