The Unwinding

By Bryce Covert

During the acute phase of the pandemic, it was easy to get on—and stay on—Medicaid. But then the “unwinding” began.

WILLIAM FLOWERS found out he had lost his Medicaid coverage when he went in for a routine doctor’s appointment in June of 2023. This was more than an inconvenience for the thirty-seven-year-old Arkansas resident—it was a life-threatening event. He has suffered from seizures since he was a toddler, and he also has cognitive disabilities, heart and kidney diseases, high blood pressure, high cholesterol, and prediabetes.

William has a part-time job at Pizza Hut, but that doesn’t grant him any benefits. He’s relied on Medicaid, the government health plan for low-income Americans, to ensure he can get his medications and go to the doctor for the last six years. He takes over a dozen drugs to control his conditions; refills of his seizure medication alone would cost him about $150 a pop without Medicaid. After he lost coverage last summer, he was able to get a handful of prescription drugs through a financial assistance program at his local hospital, but he had to stop taking the ones he couldn’t afford, including the medication for his seizures.

William’s sister Kimberly Flowers, forty-five, is his chief advocate. “It’s been really hard,” Kimberly said. “It can be a struggle, especially when you have very little money and you’re trying to decide if you can go to the hospital for a particular visit.” Kimberly has had to become an expert in dealing with the public benefits bureaucracy, which requires an almost superhuman degree of persistence and patience. The Flowers family never received any notice from the state that William had lost his coverage. Kimberly knew her brother was still eligible: he was making the same amount of money he always has, which is below the state’s eligibility threshold.

So she called the Arkansas Department of Human Services for the first of many times on his behalf. She’s had to wait as long as an hour on hold to talk to someone—and that’s when the line doesn’t suddenly go dead and cut her off. Even when connected, Kimberly often spends another half hour on the phone, depending on how helpful the representative is. “You’re being transferred from person to person, but no one has any answers,” she noted. Eventually she was told that her brother made too much money and no longer qualified for the program.

“Even when connected, Kimberly often spends another half hour on the phone, depending on how helpful the representative is.”

Kimberly was determined to get him back on Medicaid. She contacted the general manager at the Pizza Hut where he works and asked for copies of his pay stubs, then compiled them with the paperwork to file an appeal of his disenrollment. She went to a local print shop to scan the documents so she could email them in. “It can be very time consuming and a bit annoying,” she said. (Bringing the documents in person to a DHS office would be worse, though; it easily takes two hours to get called up to a window to hand them over, and the agency has a track record of losing them.) She was told the agency had thirty days to review the appeal and then someone would get back to her about the outcome. “Their favorite [phrase] is, ‘We’ll get back with you,’ or ‘We’ll have someone contact you,’” Kimberly said. But “they don’t try to follow up on anything, contact you in any way.”

She dutifully waited those thirty days, and when she didn’t get a response, she called yet again. Once she got through, she was told that her brother’s case had been closed just two days after she had been instructed to wait thirty days. The representative told her she didn’t know exactly what had happened, but that she would escalate the case, and someone would give Kimberly a call. “Give us a little time,” she was told.

She gave the agency a month without any contact and then called back. She was informed, once again, that William made too much to qualify and was instructed to send his paperwork in to file another appeal. So again, Kimberly asked his boss to print out pay stubs, filled out the requisite forms, scanned them, and sent them in. Despite the multiple attempts to get his coverage back, William’s case was still closed as of January of this year. The lack of medications caught up with him that month, and he fell sick and was hospitalized.

Continue reading “The Unwinding,” an essay by Bryce Covert, on our site.

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