My Experience with Applying for Medicaid Was Awful

Medicaid was created in 1965 by an act of Congress to create a health care insurance system for those who do not have sufficient means to pay for medical care themselves.

The law says that Medicaid is to furnish medical assistance on behalf of various individuals, including families with dependent children and elderly people, whose income and resources are insufficient to meet the costs of necessary medical services.

Instead what we have today is a mind-numbingly complex state-run bureaucratic system that creates barriers to fulfilling its own mission, as I learned first hand over the past year and a half.

Full disclosure: I was applying to Medicaid on behalf of, not myself, but my mother. In November 2017, my mother became disabled by a stroke. At the time she was living in a retirement community in California and had care available to her. She also is enrolled in Medicare, the federal health insurance program for all people over 65 years old.

But Medicare has limits to what it will pay for. Specifically, if someone needs medical care for a condition that lasts more than 100 days, Medicare won’t pay for it.

The stroke my mother had left her dependent on a wheelchair, unable to get into and out of the wheelchair without assistance due to a paralyzed left arm and leg, and with aphasia (or maybe dys­phasia) that disrupts her verbal speech. She now lives in the nursing home section of the retirement community. The cost of her care ate through her remaining assets in a short amount of time, leaving her bankrupt.

Medi-Cal’s cheery promotional material hides the grim reality.

At that time, the family was advised the apply for Medicaid. (The California version of Medicaid is called Medi-Cal, but I will use the term “Medicaid” throughout this piece unless the context warrants otherwise.)

Here is what we learned:

Applying for Medicaid is not easy. The State of California gives the impression that applying for Medicaid is not complicated. Perhaps it’s a bit like enrolling in school: there are some forms to fill out but it’s mostly a matter of getting the right information together. “There is no wrong door when applying for health coverage in California,” the state tells you.

In reality, applying for Medicaid is time consuming, opaque, and frustrating. So much so that there are people/organizations that serve as an advocate on one’s behalf to ensure that you get the benefits you are entitled to receive. In California, Medi-Cal’s website includes information about Enrollment Centers and Certified Enrollers that, presumably, help individuals through the process. I applied online–an option that the state implies is no better or no worse than the other options. However, the director of accounting at my mother’s nursing home said at the time that “most don’t apply that way.”

That should have been a red flag. One elder law firm says that for someone living in a nursing home who needs to apply for Medicaid, “submitting an application for nursing home benefits without an attorney’s help is not a good idea.”

Health care in retirement is expensive and insurance coverage is not guaranteed. According to at least one source, “Seven out of ten couples reaching 65 can expect at least one partner to use a nursing home. The average cost of a nursing home can range from $8,800 to $25,000 [per month] without Medi-Cal Benefits.” As noted above, Medicare does not cover care that lasts longer than 100 days (long-term care). With my mother, her health care costs have averaged about $12,500 per month. She’s at reasonably decent but not overly luxurious nursing home. In California, the statewide average cost is about $9,000 per month, or about $110,000 per year if you are paying out of pocket, which is twice the cost of paying full price to attend Harvard. And this is the average cost that would pay for average care.

Medicaid does not have an incentive to act quickly. According to the state of California, the time between a completed Medicaid application and the beginning of benefits is “normally” 45 days. However, I applied on Mom’s behalf in March 2020. It was not until August of 2021 that she was approved. Way beyond 45 days. Thankfully my mother is somewhere where her care continued while the application was pending and after nearly a year of waiting, the nursing home hired lawyers to help. I feel sorry for people who are in urgent need to receive Medicaid benefits, as the waiting must create an extreme hardship for them, and they’re unlikely to be able to afford lawyers.

Remember, Medicaid programs exist for the precise purpose of providing a way for people of low or no income to pay for necessary health care. To not deliver that looks to me like a failure to achieve the mission.

Applying for Medicaid is a Byzantine process: As I discuss further below, Medicaid has many barriers built in because the lawmakers who created or amend the laws and the bureaucrats who implement the Medicaid programs are very suspicious. Granted there is a significant amount of waste and fraud in Medicaid, but it seems that the systems put in place to try to address that only end up hurting the people who legitimately need the resources.

In my mother’s case, her paralysis and her inability to verbally communicate meant that she could not apply for Medicaid herself and I, holding power of attorney for her, was the one who did it for her. I live in Maryland and submitted the application online (no wrong door, remember?). I was subsequently told that one gets better results if one engages directly with the county human services agency, as in making an appointment and showing up in person. Of course, that is prohibitively difficult for someone like me who does not live in the county. Not to mention that there is a global infectious disease pandemic going on this whole time.

I received some items in the mail acknowledging the application and saying it would be referred to the county human services agency — a bad sign I now realize. One of the documents said this: “The Medi-Cal office in your county will contact you if they need more information.” Again, according to California, a county social services office may be in contact by mail or by phone to request paper verification if income, citizenship, and other criteria cannot be verified electronically. If that contact happened, it wasn’t with me. Frankly, I’m baffled about who they contacted, if anyone.

Shortly after that, I have received a “notice of action” letter from Medi-Cal, and it was to deny benefits because I failed to submit additional documentation that was never requested by them. It feels like I was set up to fail because they counted on the fact that I was out-of-state and therefore could not deal with the situation in person. The application I submitted was under suspicion from the beginning, and it took lawyers to break the logjam.

The bottom line for me is this: Americans are deeply conflicted over who pays for health care. While some modern democracies have implemented (successfully) a national health care system, America continues to have a slap-dash, jury-rigged system, filled with suspicion and political maneuvering.

This is at least in part because a significant number of Americans feel that one must earn or be deserving of health insurance, rather than it being a right that all citizens and noncitizen residents should have. Hence, people receiving Medicaid are receiving “entitlements” and “handouts* rather than simply receiving health care. This ambivalence, along with much hand-wringing over controlling costs, creates a system filled with empty promises.

As the elder care law firm says, “Congress does not want you to move into a nursing home on Monday, give all your money to your children (or whomever) on Tuesday, and qualify for Medicaid on Wednesday.” But what is so wrong with that? Where is the harm in that? I think this setup has little to do with any material reasons and everything to do with philosophical and political belief.

*Quotes from the report linked to: “However, the real problem in welfare is neither an accounting issue (how poverty is measured) nor bureaucratic inefficiency but the moral hazard of existing welfare programs’ tendency to discourage self-support through work and marriage.” And Medicaid and other assistance to low-income individuals are “a massive system of ever-increasing welfare handouts distributed to an ever-enlarging population of beneficiaries.”

Perhaps Travel is Not the Key to Broader Horizons

Growing up in California in the 70s and 80s, one of the refrains that I occasionally heard was that travel outside your home will expand your horizons. But does it?

We all have our cultural idiosyncrasies that are a result of where we grew up and who we grew up with. The challenge, then, is what do we do with that. As a young person, I was very much a product of California, a state so vast and independent–almost as if it were its own country–that one could live a full and varied life and never once leave the state. (Some people live a crabbed and limited life and never once leave the state, but that’s a topic for another time.)

Anyway, I have family in New York and traveled a bit in high school, so I was not as parochial as some. But I had a lot to learn, and still do.

Which brings me back to my original point: does travel open doors to greater understanding, as some travel writers suggest? (A recent article proclaims “To travel is to learn.”)

My gut reaction is yes, it does. It seems to me that once you see that there are different ways to achieve the same or similar results, you begin to understand that there is not (with some exceptions) one right way to do things.

And if there isn’t one right way to do things, that means that there are multiple ways of being that are just fine. With an open mind, one will see, at the very least, that one’s preferred (or accustomed) way of doing things may not be the best way.

Growing up, I was acquainted with a elderly couple, Frank and Helen Hitchin. The Hitchins were devout Christians and had spent time doing missionary work in other countries to evangelize the message of Jesus. Frank had spent time in the Belgian Congo and later, both went to Tunisia. There may be other countries that I am not aware of.

In my memory, the Hitchins were stodgy and dull, despite all of their worldly travels. This may be explained by the fact that they were old and I was young. But my grandparents were also old and did not seem nearly as stodgy and dull as the Hitchins.

Photo: Amitav Ghosh

I have a copy of a letter from the Hitchins that I recently obtained. My mother and I were sorting through some of her papers and we came across this letter, written to my parents in 1979 when the Hitchins were doing missionary work in Tunisia.

Most of the letter shows very little in the way of compassion for the Tunisians. Rather, it it strikes me as condescending and tone deaf. It belittles the Muslims for being impractical and bound by tradition. It asks us to be thankful that we are not camel herders and complains that there is no good sharp cheddar cheese to be had. It says with a regretful tone that all the newspapers in Tunis are in either French or Arabic, and the Hitchins cannot therefore read them.

It on the one hand says, disdainfully, that the Muslims can be “fiercely loyal” to their faith and on the other hand says that serving the Christian God is a “privilege” that is welcome despite hardship. It also seems reluctant to call Islam a religion.

And finally there’s this: “Frank just commented that sometimes he feels like [the apostle] Paul — in our rented apartment, a ‘prisoner’ of the Gospel….”

This makes me ask: why were they even there? Did Tunisia leave any impression on them, other than that they were glad to be Americans? How could their missionary work have been effective if they didn’t speak the language, and showed little interest in the Tunisian people’s lives?

So perhaps cross-cultural understanding is not automatic. As much as I’d like to think that stepping outside one’s American existence to learn something new will expand one’s horizons, maybe that’s an illusion.

Or at least debatable. Some argue that the saying that travel opens one’s mind is a false adage. “Travel does not automatically make you a better person,” says Travis Levius, a travel journalist and hospitality consultant. This appears to be true of Mr. and Mrs. Hitchens. I’m not saying that they weren’t good people, whatever that means in the long run. But their travel in the name of Jesus did not, evidently, make them more compassionate towards people of cultures that were different from their own.

True compassion transcends differences in culture, age, language, or religion. And compassion, I would argue, was one of the main teaching points of Jesus. But more on that some other time.

Epilogue: Mr. Hitchin claimed that he would not die before the Second Coming of Jesus. He died in 1996. Make of that what you will.

[Updated 3/17/22 with some corrected information on Frank Hitchin.]

Things That Did Not Cause the Collapse of Society: A List

This week, a county school board in my area took a bold step in the direction of diversity, equity, inclusion, and frankly, justice. You may have heard the news.

Those opposed to this action have offered a variety of disconnected reasons that this was the wrong thing to do. They range from claims that the action will ruin our children (it won’t) or usurp parental rights (no more than other public education actions) to claims that the action will somehow interfere with their religious freedom (to discriminate). (Here’s just one example of hyperbolic reaction.)

I would bet money that privately, people also are thinking that it is another step in the downfall of society, another inch closer to the end of the world.

People opposed to positive social change–let’s call them conservatives–have argued for literally hundreds of years that steps taken to improve a pluralistic society and advance social justice will lead to the collapse of civilization. Which we know now is absurd. But conservatives still use that argument today anyway.

So I thought I would make a list off the top of my head of some of the things that over the years did not in fact cause social collapse (approximately in reverse chronological order):

  • the legalization of same-sex marriage
  • equal funding for women’s education
  • affirmative action
  • allowing women to enroll in historically men’s schools
  • access to contraceptives
  • the legalization of interracial marriages
  • the integration of public schools
  • the integration of the Army and Navy
  • women working outside the home
  • giving women the right to vote
  • giving Blacks the right to vote
  • ending race-based enslavement of other people
  • removing the Church as an arm of the State
  • not doffing one’s hat or bowing to one’s “betters”
  • the scientific method

What does lead to a breakdown in social cohesion? Here a few things:

  • police brutality and a militarized State (ongoing)
  • lies and misinformation (ongoing)
  • environmental degradation (ongoing)
  • income inequality and entrenched poverty (ongoing)
  • unequal access to educational or economic opportunity (probably ongoing)

As usual, I am thinking of America as I write this. I realize that many other countries are at different stages of their journey toward a modern society and I wish them the best.

America can and ought to be better than we often are. I’m constantly amazed and saddened by how many Americans want to turn back the clock and erase so much of the hard-won progress that has been made over the centuries. At the same time, I understand that those people whose identity is threatened the most are the ones who will scream the loudest.

Which raises the question of who would create their identity around maintaining injustice and inequality? Think about it.

I, for one, think that regression to some imagined former “greatness” at the expense of general social improvement would be mistake.

P.S. It is good to remember that one’s personal opinions about how things “ought to be,” no matter how strongly held or deeply felt, are not “truths” that cannot be challenged. They are only opinions and can be heeded or dismissed as circumstances warrant.

Just a Paycheck

A comeback that is 25 years in the making can hardly be considered “snappy” but here it goes.

The first three years after I graduated from college, I spent in food service. And one day, on a day off, I was at a function with my now wife and some of her co-workers. I was sharing a conversation I’d recently had with one of the cooks at the restaurant I was working for at the time. I’d asked if he cooked much at home and he told me that most days he just makes a sandwich and has a beer.

One of my wife’s co-workers, who had some experience in running a restaurant, said something along the lines of “Well, he most not be a real cook, because the real cooks I’ve worked with continue to create in their kitchen at home.”

At the time, I didn’t know what to say. She was older, presumably more experienced, and I was not one to argue.

But in the intervening years, I have learned that, for many people, a job is…

Just.

A.

Paycheck.

It would be wonderful if we all could be gainfully employed in an occupation that we find ourselves uniquely suited for, that gives us companionship with colleagues and the satisfaction every day of a job well done.

But not every job is the perfect job, and not everyone has the privilege in their life of finding something that even resembles perfect. The laws of supply and demand remove many of our choices to somewhere beyond our grasp.

In the meantime, the bills have to be paid and there are mouths to feed. There is trash to be collected and sewers that need to be unclogged. There is vomit that needs to be cleaned up, roadkill that needs to be moved out of the road, asses that need wiping.

As I’ve said before, there are some people of a certain political point of view who say that everyone should be grateful simply to be employed. And I will allow that being employed has merits in an of itself. But the gratefulness is a stretch when the best you can say about your job is that it is just a paycheck.

So yes, there are certainly some “real cooks” out there who are passionate about preparing food. And then there are others (probably many others) for whom the work at the stove and the plating of the food is just a means to an end. When they clock out, they’d rather not think about it until the next shift.

And it would be best not to confuse one for the other.

There’s a fine line between “work[ing] like a soul inspired until the battle of the day is won” and “hanging on in quiet desperation.” Most of us take comfort believing that there are working heroes, who pour their soul into their occupation day in and day out (lots of TV shows about that). But if you peel back the curtain a bit, the reality is far more bland and nuanced, and we should neither think better of ourselves for it nor judge others (or ourselves) more harshly.

There. A not-so-snappy comeback.

Compassionate Inquiry on Wrongness

What do you call someone who privately knows they may be wrong about something but publicly advocates in favor of it, sometimes with intense fervor, because to admit they are wrong would be against their interests?

A weasel? An asshole? A hypocrite? A lost soul?


A lot of political cataclysm comes from people doubling down on things because of an unwillingness to say, “Maybe I was wrong.” Those actions affect their lives but also the lives of all the people they come in contact with and cause a lot of damage for everyone else.

Actor Joel Edgerton, in the Washington Post


For a long time, people kept many of their opinions to themselves, for a variety of reasons. But today, people’s lives are so we’ll documented, and we have more ways of learning fact than ever before in history, that now we have many examples of this kind of clinging to wrongness.

For instance, there are those who cling to the belief that the Earth is flat. There are those who hold deeply conservative religious views and who show no interest newly revealed truths. We have people who believe there is evidence that Donald Trump won the 2020 presidential election.

Is this wise? If not, why does it happen with alarming frequency?

Based on casual observation, it appears that such persons take psychic refuge in what they are believing. Their belief system–political, religious, views of human nature–provides value to them, often in the form of a coherent narrative to their lives. Which is what belief systems have done for tens of thousands of years, so it’s human. But more often than not, such beliefs can conflict with new ways to understand the world. People willing to adapt will learn to adjust. Others, even in the face of evidence, dig in their heels.

At that point, the humane thing to do is quietly but firmly inform them of their wrongness, be strong and ignore their continued attempts to assert their opinions, and be compassionate. Some of these people can be redeemed but many are so caught up in their belief system, sometimes with intense fervor, that they are essentially lost.

Interestingly, Jesus said much about hypocrites while he was teaching 2000 years ago, none of it good. Somewhere along the line, many people stopped listening to that teaching and instead doubled down on their out-of-touch beliefs. But also, Jesus–and the Buddha, and Hindu scriptures–teach compassion for the lost.

Wise teaching indeed.