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Mending The Medicaid Gap

February 20, 2014, 10:07 PM by Don Jorgensen

Mending The Medicaid Gap

Thousands of South Dakotans are caught in what's been dubbed the Medicaid Gap.

They don't qualify for Medicaid, but don't make enough to afford health insurance through the Affordable Care Act's marketplace.

Right now, state lawmakers are looking at whether to expand Medicaid, but it still might not be enough to help the working poor.

"I guess my situation is kind of normal of a person my age," Rachel Doonan said.

Doonan is 25 years old; single and a mother of two.

"I'd just like to be free to go to the doctor when I need to," Doonan said.

Doonan is one of thousands of South Dakotans who fall into the so-called Medicaid Gap. 

She doesn't qualify for Medicaid, but doesn't make enough to afford health insurance on her own.  

As a result, Doonan says she's been purposely avoiding going to the doctor and that scares her.

"I've probably neglected normal routine care, physicals for about five years, kind of been tough," Doonan said.

She's just getting over the flu; an illness she says was so hard on her that she had no choice but to go to the doctor to be treated. 

"I already got a bill for that and it was like $1,000 just for that. Plus, I got a prescription for Tamifu and that was like $160 out of pocket," Doonan said.

A provision of the Affordable Care Act allows states to expand Medicaid and receive graduated funding reimbursement from the federal government. Currently, South Dakota's program doesn't cover adults who aren't elderly, don't have dependents, or do not have a disability.

South Dakota governor Dennis Daugaard has proposed expanding Medicaid to include low-income adults who are working or have become recently unemployed that make 100 percent of the federal poverty level or less.

"I'm pleased the governor has taken to the 100 percent, we're wanting to hear whether we'll be allowed to do the waiver," State Republican Representative Ann Hajek said.

Hajek says she supports covering more South Dakotans. She says if the legislature passes partial expansion of Medicaid that would help low-income families and those who make 100-138 percent of the Federal Poverty Level can go to the exchange and receive subsidies.

But Doonan, along with an estimated 26,000 other South Dakotans doesn't make enough to qualify for the subsidies. That's why Democrats want full expansion covering 138 percent of federal poverty level. If the legislature doesn't vote in favor of expanding Medicaid to that level, some would like to put the issue to a public vote.

"The full expansion allows us to reach a wider population for people who really need it, who need that help," State Democratic Representative Paul Hawks of Hartford said.

If it passes, it would mean health care coverage for nearly 50,000 low-income South Dakotans, including Doonan.

"We are talking about single adults who are working, we're talking about married adults who are working, who don't qualify for Medicaid as it sits now, they don't have the ability to qualify for the exchange or can't afford to be a part of that health insurance pool, they have at work, so we're really talking about the working poor," Hawks said.

Right now there's no agreement on expanding Medicaid in the legislature.

"I think the debate is definitely not dead. I think it'll keep going. You do what you can and have to be hopeful," Hajek said.

Doonan is hopeful the legislature expands it enough to include her and so many others who now fall into the Medicaid Gap. 

"I'm not lazy, I don't just sit at home all day, I go to work, it's like punishing me for not making enough to get health insurance, but not being lazy enough to qualify for Medicaid," Doonan said.

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