Confusion about Medicaid keeps older adult from care he needs

There’s one outcome of the challenges with Medicaid that stands out to Lisa Westhoff, a Regional Oral Health Specialist with Community Health Services in Aspen. One of her older patients recently lost Medicaid. He can’t afford co-pays available under Medicare. And he can’t understand why any of it is happening.

“The growing number of individuals losing Medicaid benefits stretches our resources thin, making it increasingly difficult to provide care without compromising the sustainability of our services. Our priority remains ensuring that vulnerable patients receive essential care, even as we face the broader challenges of the Medicaid unwind.”

~ Lisa Westhoff, a Regional Oral Health Specialist with Community Health Services in Aspen

Westhoff’s older dental patient qualifies for both Medicaid, due to financial need and Medicare, because of age. He visited Westhoff’s clinic over nine months ago. Since Medicare doesn't cover dental care, the clinic planned to bill Medicaid for his dental hygiene services. However, after the appointment, they discovered his Medicaid had expired, and he only had Medicare.

At his next scheduled visit, the clinic informed him about the expired Medicaid. He was confused and presented a Medicaid card from years past, claiming he never canceled it. Clinic staff explained to him that he likely missed a verification process and connected him with in-person help to re-enroll in Medicaid, as he was likely to still qualify due to his low, fixed income.

That same day, the local navigator questioned why he needed Medicaid if he had Medicare, highlighting the common confusion between the two programs for older adults and even those charged with assisting them in attaining coverage. Clinic staff explained the ability to have coverage under both programs based on need and age. Assuming the issue was resolved, the clinic staff scheduled a follow-up appointment.

Unfortunately, when the patient returned, Medicaid still listed only his Medicare coverage. He couldn't afford even the discounted rate of $35, so the clinic postponed treatment and connected the patient with Mountain Family Health to help address his Medicaid issue. At that time, he also mentioned his need for new glasses, which Medicare wouldn’t cover, further highlighting his financial struggles.

Westhoff’s clinic has committed to seeing him at no charge during his next visit, regardless of his ability to pay, while they continue working to help him navigate the system and restore his benefits. While this is the right thing to do, it places an undue strain on the clinic.

And it highlights the real impact of the Medicaid "unwind" that has affected thousands of Coloradans.

“The growing number of individuals losing Medicaid benefits stretches our resources thin, making it increasingly difficult to provide care without compromising the sustainability of our services,” Westhoff said. “Our priority remains ensuring that vulnerable patients like this man receive essential care, even as we face the broader challenges of the Medicaid unwind.”