A Medicaid Odyssey: A Wyoming woman’s long, winding road to health coverage

Fawn Marie Reed

Guest columnist Fawn Marie Reed cradles her newborn daughter in this file photo. Reed underwent a years-long struggle to obtain Medicaid coverage for her and her daughter from the state of Wyoming. (Courtesy of Fawn Marie Reed)

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Guest column by Fawn Marie Reed
January 8, 2013

I was that person at Cody High School. The one who never studied for exams yet earned high marks, a soprano in chorus and jazz choir, an actress in school plays and a star member of the forensics team, all while working a part-time job. I earned a forensics scholarship to Northwest College, and then transferred to the University of Wyoming on an academic scholarship.

After three years, several academic major changes and two part-time jobs, I left Wyoming without a degree. I went to Alaska and worked in media advertising. I felt like such a grownup with my business cards, company-issued cell phone and health insurance.

After four years, I tired of the frigid blackness of Alaskan winters and returned to the University of Wyoming to finish my degree. Being a nontraditional student was more difficult than I expected. Everyone I’d known was long gone and only the campus buildings remained familiar. My first semester grades were neither stellar nor horrifying. But I was still recognizable as myself.

Over the course of the next semester, even that began to change. I quit going to class, called in sick to work and avoided calls from friends and family. I waited for the dead of night to shop for groceries, collect my mail or wash my car. After a final night spent slicing my forearms with the broken shards of a wine bottle, I realized I needed help.

I spent several hours occupying a scuffed, orange plastic chair in the corner of the student health center before being ushered into the therapist’s office. I recounted my story in a small voice, avoiding eye contact by picking at a stray piece of tape on the corner of her desk. When I finished, she diagnosed me as “a textbook case” of bipolar I disorder.

The university didn’t have a psychiatrist on staff, and my Alaskan health insurance had long since expired. I didn’t see how I could afford private care. I decided that knowing what was wrong would be enough to avert any future catastrophes. Within six months, I was hospitalized after swallowing 46 sleeping pills.

I returned to my mother’s house in Cody and sought treatment through Yellowstone Behavioral Health Clinic, where doctors and therapists set fees on a sliding scale. I was soon in therapy and immersed in a trial-and-error quest to find the pharmaceutical mix that would stabilize my moods.

For nearly a year, I struggled to simply shower, comb my hair and brush my teeth. I could barely leave the house, much less hold a job. For a time, my father paid almost $500 a month for my medicine, but he soon tired of the burden.

A map of mental health treatment providers in Wyoming

A map of mental health treatment providers in Wyoming. (Courtesy of Wyoming Department of Health — click to enlarge)

I researched the patient assistance programs offered through various pharmaceutical companies and eventually received two of my three medications at no cost. Every three months, the application process had to be repeated.

Eventually, I felt stable enough to find a job. For years, I worked full-time at job that paid a bit above minimum wage and offered no benefits. My income remained low enough to qualify for patient assistance. I paid an average of $8 per therapy session or doctor visit. Neither I nor my employer paid the actual cost of my care. I relied on the charity of drug companies and the clinic. But that was about to change. I would soon get health coverage in a way that is not unusual for young single women.

At 33, I began a casual relationship with a man I barely knew. By the time I realized I was pregnant, he had left town and disconnected his cell number. As often happens with low-income women, I realized that despite my full-time job I couldn’t afford to be pregnant.

I applied for Medicaid through the local Department of Family Services office and was accepted for prenatal care coverage. My pregnancy wasn’t without complications, and I can’t express the gratitude and relief I felt in knowing that I would get the care necessary to ensure a healthy pregnancy.

My beautiful, healthy daughter arrived in January of 2009 and was immediately covered by Children’s Health Insurance Program, part of Medicaid. Every year, I fill out an application and submit the paperwork necessary to renew her healthcare coverage. As a mother, the knowledge that my child will never have to forgo medical attention due to my inability to pay provides immense peace of mind.

I continued to receive Medicaid coverage for 6 months after my daughter’s birth. In order to extend that coverage, I had to either cooperate in the government’s effort to collect child support from my daughter’s biological father or submit proof that contact with him could result in physical or emotional harm to my daughter or me.

In his absence, I had discovered some unsettling details about the character and criminal history of my daughter’s father, so I chose to cooperate with the government. I believed he posed a danger to us. Unfortunately, no one in the Cody office had experience dealing with this type of “good cause” claim. They couldn’t offer much guidance on how to actually collect the required proof. I let it drop and went without health coverage.

When my daughter was 7-months-old, I enrolled at Northwest College hoping to finally earn the degree my mental illness had forced me to abandon. In May 2010, I graduated with honors, earning an associate’s degree in communication. That fall, I transferred to the University of Wyoming to finish my bachelor’s degree.

Unsure how quickly I could gain access to an Albany County counterpart to Yellowstone Behavioral Health Clinic and unconvinced that the student health center could meet my needs, I contacted DFS. I hoped my new case manager might have experience with “good cause” claims. She didn’t.

Frustrated, I contacted a friend with more legal expertise than I. I had a vague notion of the biological father’s background but was short on specifics. With her help, I uncovered three criminal convictions in Wyoming alone.

This, I learned later, should have been enough to reinstate my Medicaid coverage. But it was not so simple. Armed with photocopies of the court records, I met with my caseworker. She told me that one of her superiors would determine whether my evidence was sufficient, and she’d let me know what was decided. My follow-up calls were not returned; I never heard from her again.

Months later, I met with a new caseworker to renew my daughter’s Medicaid coverage. By her assessment, my “good cause” claim and accompanying proof were never submitted. She assured me she would follow through on my claim and let me know. I never heard from her again, either.

A year later, I met with another new caseworker for my daughter’s annual Medicaid renewal. She delivered the exciting news that I’d been covered by Medicaid for the past year. Unfortunately, my year of super-secret health coverage was at an end, and I would have to go through the application process all over again. Thankfully, I didn’t hold my breath in anticipation because once again, follow-up calls and emails were never returned.

In the meantime, I saw a physician at the student health center who felt comfortable, given my established treatment history, to write the prescriptions and fill out the paperwork necessary to allow me to continue accessing the pharmaceutical companies’ patient assistance programs. Without his help, I very well could have been forced to stop taking my medication altogether.

In May 2012, I completed my education and moved back to Cody. I met with a local DFS caseworker and was told that I’d had Medicaid insurance since February. I felt grateful for this information as I worked to reestablish the support necessary to manage my bipolar disorder.

Cody, Wyoming

When Reed graduated from the University of Wyoming and moved back to Cody in May 2012, she was surprised to learn that she’d been covered by Medicaid for months. (Stereogab/Flickr — click to enlarge)

For the past 2 years, I’ve had health insurance. Granted, I’ve only known about it for the past few months, but I’ve been covered nonetheless. I’m not the mythological “welfare queen” your parents warned you about. Outside of my pregnancy, I’ve used Medicaid for exactly one doctor visit.

Next month, I have to reapply for Medicaid. Once more, I’ll submit proof that my daughter’s biological father is a danger to us. Should I be denied, I would go without coverage rather than involve him in our lives.

I was raised to rarely ask for help and never accept charity. But being a responsible parent means putting aside my pride and accepting help when I need it. I’m no good to my daughter if I land in a hospital again, so for now, I need help. And I’m thankful for it.

Fawn Marie Reed spent her early years as a military brat before her family settled in Cody, Wyoming. She is a single mother, aspiring fiction writer and holds degrees in communication from Northwest College and the University of Wyoming. Currently unemployed, she spends her days emailing resumes and catering to the whims of a demanding toddler.

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Published on January 8, 2013

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