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In the world of social programs, Medicaid is one of the hardest to understand. It’s something of a catch-all program for low-income people, covering broad and divergent needs. Included are healthy children and adults with eligible dependent children, people with disabilities or special health needs, and the elderly. Eligibility is income-based and it varies according the category of qualification for the program.During the state’s 2011 fiscal year, more than three quarters of the funding allocated to the Department of Health and Welfare’s budget went to Medicaid. The program received about $1.55 billion in federal and state funding, with 74 percent of those dollars coming from the federal government.Enrollment in Idaho’s Medicaid program has grown substantially in recent years. The average monthly Medicaid enrollment was fairly stable between 2006 and 2008. It grew by about 3.5 percent. But in the last three years, the program’s enrollment has grown nearly 21 percent. Ballooning from about 185,000 in 2008 to 228,897 in 2012.

As Idaho And Utah Vote On Medicaid This Fall, Patient Health Options Hang In The Balance

If you’re poor and you get really sick in Idaho, your health care options might be really different than say, if you live in Colorado or Montana.

 

That’s because Idaho and Utah opted NOT to expand Medicaid - the government funded health program for low-income people. But this November, voters might change that in both of those states.

Living With Health Issues In Idaho

Donna Scranton doesn’t know what’s wrong with her.   

“I’ve been tested for Lupus, HIV, MS, dystonia, Lyme disease, EEG for seizures,” says the 60-year-old Boise resident. 

Scranton has an undiagnosed neurological disorder, and she’s one of up to 62,000 Idahoans who would receive health insurance under Medicaid expansion.

Several times a day, she loses control over portions of the right side of her body. During one of these “episodes,” as she calls them, her face droops and her eye closes. Her arm and leg muscles cramp up into painful charley horses that leave half her body swollen and aching. 

Her doctors told her the symptoms are a lot like strokes or multiple sclerosis, but she’s tested negative for both. It all began about five years ago. 

At the time, Scranton was working with autistic children as a behavioral therapist. Back then, she had health insurance, but her doctors couldn’t figure out what was wrong. Her condition got so bad that she had to stop working, which meant she lost her health benefits.

“All I know is that it’s a functional neurological disorder but they can’t find the disorder,” she says. 

Today Scranton gets about $1,150 in monthly disability benefits. But as a single woman on a limited income, she didn’t immediately qualify for Medicare. There’s a wait period of two years for that. However,  if Idaho voters opt to expand Medicaid this fall, she’d be covered immediately. 

“I need to be under the care of a neurologist, so that they can watch the progression and treat the progression,” Scranton says. She hopes that additional tests or new technology might help doctors diagnose her condition. 

Instead she says she can only afford to see a general practitioner who charges on a sliding scale based on patient income. If she lived somewhere else, things could be different.

Thirty-four states opted to expand Medicaid under the Affordable Care Act. Diane Rowland is with the Kaiser Family Foundation, a nonprofit health policy think tank. She says the expansions helped millions of uninsured people get healthcare. 

“There’s no one picture of the individuals who could benefit, but the one common characteristic is that they’re all going to be very low income,” says Rowland.

 

A Different Story In Colorado

As a graduate student, Reyna Ulibarri was earning a few thousand dollars a year when Colorado expanded its Medicaid program and she became eligible even though she was single. A couple of years ago, she was just wrapping up her dissertation when life changed dramatically. She got into a terrible car accident. 

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Credit Reyna Ulibarri
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Reyna Ulibarri
Reyna Ulibarri lives in Colorado, where Medicaid expansion went into effect January 2014.

“It was a hit and run,” says Ulibarri. “No one ever stopped. One minute we were just driving along, the next minute I now am regaining consciousness, slowly aware that there’s an intense pain in my head."

Ulibarri was rushed to an emergency room in an ambulance, where she saw doctors who diagnosed her with a traumatic brain injury. She says she never would have gotten that level of care, much less gotten into an ambulance, had she not had Medicaid and the doctors it paid. 

“That would be so much worse if I didn’t have medical knowledge behind me this whole journey,” says Ulibarri. 

She still needs a great deal of care. Her vision is impaired, she gets tired easily and she has trouble concentrating.

“I really can’t read comfortably, which an impossible thing to have if you want to be a professor,” Ulibarri says.  

Her Medicaid coverage allows her to get physical therapy and more treatment, and she hopes she’ll soon be able to work again. 

That’s a prospect that feels far away for Donna Scranton in Boise. She used to love fishing, camping and playing with her grandkids at the park. Those activities feel impossible now.

“I would love to be able to walk again,” Scranton says. “I would love to be able to use my right arm again. 

Scranton says if Idahoans vote to expand Medicaid coverage this fall, the first thing she’s going to do is make an appointment with a neurologist. 

Meanwhile, her seizure-like episodes have been getting worse. She recently went to the emergency room because she had a muscle attack in her neck that started constricting her throat. That was a new symptom. 

“The mental anxiety of this is probably the hardest because when I do get a new symptom I want to go to the doctor. I want to say, 'look, now it’s doing this. What’s my prognosis now?' I don’t even know that. This might be killing me. I just don’t know." 

Find reporter Amanda Peacher on Twitter @amandapeacher.

Copyright 2018 Boise State Public Radio

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, Yellowstone Public Radio in Montana, KUER in Salt Lake City and KRCC and KUNC in Colorado.

 

Amanda Peacher works for the Mountain West News Bureau out of Boise State Public Radio. She's an Idaho native who returned home after a decade of living and reporting in Oregon. She's an award-winning reporter with a background in community engagement and investigative journalism.