Shirley Jackson, 68, seen Thursday in her South Berwick apartment, says she can no longer earn money other than her Social Security income or she will be dropped from Medicaid rolls because of financial eligibility requirements. She says while she feels lucky compared to others who will be cut, her income leaves little room for even modest extra spending.
By Kelley Bouchard
Sarah Dunlop is terrified for her life in the wake of this week's news that Gov. Paul LePage has won federal approval to eliminate or reduce Medicaid benefits for more than 20,000 low-income parents, seniors and disabled Mainers.
Like others who may be affected by the cuts, which take effect March 1, Dunlop hasn't been able to find out exactly how the state's $4.5 million Medicaid spending reduction will affect her.
She called officials in the Department of Health and Human Services, she said, and they told her that a letter about her future Medicaid status will be mailed at the end of January.
In the meantime, Dunlop, 49, a longtime insulin-dependent diabetic who has been disabled by mounting health problems for more than a decade, is left to wonder whether she will lose prescription drug coverage that she says keeps her alive.
She gets only $710 a month in Social Security benefits, while her rent is $700 a month and insulin would cost her $300 a month.
"I'm very afraid," Dunlop said Thursday in a telephone interview from her home in Mexico, near Rumford. "I don't know what's going to happen if I'm eliminated. I don't know if I'm going to have a life after this. It won't take long for me to go if I don't have insulin."
On Monday, federal officials notified the LePage administration that it could go ahead with two of four requested spending reductions in MaineCare, the state's Medicaid program.
LePage sought, and the Legislature approved, the reductions last spring during state budget negotiations -- before a $100 million Medicaid shortfall came to light in November.
Mary Mayhew, Maine's commissioner of health and human services, said Tuesday that the reductions are difficult to make but unavoidable and won't go far enough.
On Friday, LePage is expected to present a budget for the two years starting July 1 that will include additional cuts to health and human services programs.
The Obama administration rejected LePage's plan to cut Medicaid for low-income 19- and 20-year-olds and parents whose earnings are at 100 percent to 133 percent of the federal poverty level.
Federal officials did approve a request to eliminate coverage for 12,592 parents who earn 133 percent to 200 percent of the federal poverty level -- $30,657 to $46,100 a year for a family of four.
That approval was expected because the Affordable Care Act allows states with budget deficits to discontinue Medicaid coverage for adults who earn more than 133 percent of the poverty level if they aren't pregnant or disabled.
Federal officials also allowed the state to deny or reduce Medicaid health care and prescription drug coverage for 8,250 elderly and disabled adults in the Medicare Savings Plan and Drugs for the Elderly program. About 2,600 of those people will lose all coverage.
That approval surprised many Democratic lawmakers who opposed the cuts, and advocates for families, seniors and disabled Mainers. They say the justification isn't readily apparent in federal laws.
"We are still trying to seek clarification (from federal Medicaid officials) on that," said Sara Gagne-Holmes, spokeswoman for Maine Equal Justice Partners.
Gagne-Holmes and others described the planned Medicaid cuts as cost-shifting rather than real reductions, noting that many Mainers who lose coverage will still seek health care, often at hospital emergency rooms. That drives up costs, which are shared by people who do have health insurance.
"The greater the number of uninsured Mainers, the more likely they are to go to the emergency room, where it costs more," Gagne-Holmes said. "By then, their health is worse, because they've waited, and outcomes aren't as good."
Jim Burns, 52, is another Medicaid recipient who fears that he may lose some or all of his health care and drug benefits.
A former customs broker who lives in Amity, near Houlton, Burns has been disabled since 2008 by recurrent cellulitis, circulation problems and other complications from diabetes.
Burns isn't sure how his Medicaid coverage will be affected; he, too, was told that a letter explaining the future of his benefits will be mailed at the end of January.
John Martins, Mayhew's spokesman, confirmed that the letters will go out later this month.
What Burns knows is this: His monthly $1,332 Social Security check and $16 food stamp allowance won't cover the bill if he has to go to the hospital again, as he did last summer, for 16 days at an estimated cost of $1,000 a day.
If he doesn't get regular medical care for wounds that don't heal and other health issues, he'll wind up in the emergency room.
"It's not smart health care," Burns said. "It's penny-wise and pound foolish. It doesn't save the state or anyone anything."
Shirley Jackson, 68, counts herself lucky compared to others who face potential Medicaid cuts. She called a state information line and was told that she likely won't lose her coverage.
That's because Jackson, who lives in South Berwick, recently lost a part-time teaching job that generated about $1,400 in income last year -- a little more than $116 per month.
Now, faced with making ends meet on her monthly $1,244 Social Security check, Jackson expects to squeak under the state's reduced income eligibility guidelines for seniors and disabled Mainers.
But she'll have little financial wiggle room each month after she pays the rent on her subsidized apartment and all of her other regular bills, leaving about $200 a month for food, clothing, prescription and medical co-payments, gasoline, car repairs and other living expenses.
The prospect has Jackson feeling trapped and defined by federal poverty guidelines that say she can no longer earn more than $15,638 per year -- 140 percent of the poverty level.
Like Dunlop and Burns, she gets $16 a month in food stamps, which she augments with visits to the local food pantry.
"There's a certain amount of dignity I wish I could keep," Jackson said. "I manage, but there's a terrible price to pay."
Jackson, who is college educated, made career sacrifices and used her retirement savings to raise two daughters by herself. Now, without a part-time job to pay for extras, she won't go to movies or occasional lunches out with friends.
And she has given up hope of visiting her daughter in Atlanta anytime soon. They haven't seen each other in nearly three years.
"I was using that job to breathe," Jackson said. "Now, if I earn just $61 a month on a regular basis, it will push me over the income limit and I will lose everything. If I ever find another job, I really can't take it or I'll be punished."
Staff Writer Kelley Bouchard can be contacted at 791-6328 or at: