When a Client Faces an Awful Choice, Paying for Medication or Keeping the Electricity On, PHLP Steps In
While the Pennsylvania Utility Law Project (PULP) was helping 64-year-old Columbia County resident Evelyn avoid utility termination, they discovered she was not paying her utility bills because she was paying medical bills. So they referred her to PHLP to see if she qualified for assistance.
Evelyn receives a modest income through Social Security Disability Insurance (SSDI) and a small widow’s pension. She had health care coverage through Original Medicare, leaving her with 20% coinsurance for any health care services she received. Because Evelyn has a number of health problems that require regular care, as well as the use of oxygen, she looked into buying a Medicare supplement policy or a Medicare Advantage plan, but she could not afford them.
When our staff talked to Evelyn, we discovered she was on Medicaid, but only for the payment of her monthly Medicare Part B premium. We learned she also received the full Extra Help with her Medicare prescription drug costs, but she was still struggling with these costs ($2.95/generic drugs and $7.40/brand name drugs) because of how many medications she has to take for her health conditions.
Evelyn was only slightly over the income limit for full Medicaid benefits. Although Medicaid, an income based program, does not generally consider household expenses when determining eligibility, there is a little-known rule that allows Medicaid to deduct transportation costs to and from the bank from someone’s income when reviewing eligibility for older adults and people with disabilities. PHLP discovered that Evelyn traveled to the bank a couple times a month to access her Social Security income and, because she lives in a rural area, the number of miles she had to travel to get to her bank would be enough to bring her income below the limit.
PHLP contacted Evelyn’s local County Assistance Office and asked them to review her eligibility taking into account the monthly transportation costs to the bank. They did and approved for her full Medicaid! This covers her Medicare Part A and B deductibles and coinsurance, freeing up some of her limited income to pay other bills, like her utility bills. She also now qualifies for a lower co-pay level with her full Extra Help, reducing her prescription costs to $1.20/generics and $3.60/brand name drugs.
Evelyn is extremely grateful that she can now pay her bills! Her case shows the importance of collaboration between legal services programs-- as well as how important it is to have specialty legal aid programs, like PHLP, whose staff really understands the nuanced rules of Medicaid eligibility to help people like Evelyn get the help they need.