Is it covered?

Behind many doctors’ visits and filled prescriptions is the work of a benefits enrollment specialist.

Each week, our Benefits Enrollment team of Dawn Johnson, Noel Zeno and Sierra Ruth* help people navigate complex systems required to sign up for health insurance. From their small office off the Fallsway clinic lobby, the team fields a steady stream of questions from adults and families experiencing homelessness. 

‘How do I switch my Medicaid plan?’ ‘What are the income requirements?’ ‘What documentation do I need?’ ‘Which plans do the pharmacy accept?’ 

They also witness the frustrations of delayed care. A man gets approved for Medicaid—victory!—only to have to push back his surgery while waiting for authorization. A woman trying to switch insurance providers is bounced from one organization to another. In the meantime, she’s forced to choose between coverage for pain management or anxiety as both conditions worsen.

This is a difficult time to encourage people to enroll, the team reflects. Executive orders are targeting the people we serve, threatening incarceration if you don’t have a home or deportation without due process. “I’ve had to convince clients that ICE isn’t outside,” Noel says. “They are scared to come in and to apply—even if they are legal residents and eligible.” 

Administrative burdens in Medicaid further complicate enrollment. For adults and families without stable addresses, getting and keeping insurance is already hard. The forthcoming shift to reapply every six months and prove work hours will only make access harder. “People think, ‘They are going to cut Medicaid anyway, so why apply?’” Sierra says.
 

Image One morning, a family arrives with a toddler wearing a “little turkey” shirt. The mom sits with Noel, who switches into fluent Spanish to walk her through the application. They have their Social Security numbers. “Tienes opciones” he tells her. You have options. Aetna, CareFirst, Jai Medical Systems, Medstar Family Choice, Maryland Physicians Care, United HealthCare and Wellpoint all offer a Medicaid plan. As Noel processes the application through Maryland Health Connection, the baby babbles. He sets out crayons and small stress balls for her to play with; her dad colors with her. Within 10 minutes, their one-year-old is approved for Medicaid. The parents, legal residents, are a few months shy of the so called “five-year bar”—requiring documented immigrants to wait for five years before becoming eligible for Medicaid. They will need to come back.

More fear and more red tape puts people’s health at risk. “There’s nothing like a $15,000 hospital bill out-of-pocket,” Sierra says. “Health is expensive.” 

Noel, Sierra and Dawn do their due diligence to get people in the door. They remind clients that Medicaid is here now. Come in or call to apply and there will be a team to support. 

“You have to be extremely empathetic because people are hurting. Because that could be you,” Noel reflects. “If I don’t have a home or something to eat, the last thing on my mind is getting health insurance. So for them to come in, I applaud them.”

*Sierra Ruth recently transferred to our Housing team and now holds the role of Housing Program Assistant.

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