Open enrollment begins Nov. 1 for Medicaid expansion

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RICHMOND, Va. — Facing decades of chronic pain, Cassandra Flowers had nowhere to turn.

“You try to go places to get the help that you need and you have a whole lot of doors be slammed in your face,” she said.

From OCPD to sciatica, the 54-year-old grandmother has a long list of health problems and needed to find specialists for help.

“I was self-medicating myself because I couldn’t afford to go to the doctors,” Flowers explained.

She says she was medicating with heroin. 

For 20 years, Flowers has struggled with addiction.  

“I’m in so much pain that I’m not thinking about how I can die,” she said. “I’m just thinking of trying to get healed right there at that moment because I’m in so much pain.”

But things are looking up. Flowers put herself into a recovery program with Richmond Behavioral Health Authority (RBHA).

Out of the people who come into RBHA for substance dependency problems, between 75-80 percent of patients are opioid dependent.

Flowers is currently insured under the Governor’s Assistance Program, or GAP, which has some limitations. While she can work with RBHA for substance dependency problems, Flowers cannot see the specialists need for the chronic pain she faces.

As of Thursday, low-income adults in Virginia can start enrolling for Medicaid starting on November 1, after coverage was expanded this year. Roughly 400,000 adults are eligible. Those enrolled under the GAP program are rolled over into Medicaid.

The new coverage is available to men and women ages 19 to 64 who are not eligible for Medicare. Income requirements vary by family size. For example, a single adult with an annual income  at or below $16,754 may be eligible. An adult in a three-person family with a total household annual income at or below $28,677 is in the same boat. .

“It was a long time coming, but we’re glad it’s here,” Gov. Ralph Northam (D-Virginia) said.

Democrats pushed for over four years to get Medicaid expansion passed in the General Assembly. Expansion efforts were blocked in the past by Republicans who claimed the long-term costs were unsustainable.

Gov. Northam says the expansion passed “the Virginia way.”

“We can agree to disagree but at the end of the day we need to do what’s best for Virginians. So people from both sides of the aisle were responsible for this,” he explained.

The coverage also expands options for providers, like the Richmond Behavioral Health Authority, to treat patients with substance abuse problems. James May, the director of substance abuse services at RBHA says the funding from Medicaid expansion “opens the door” to more treatment options. They’re currently expanding the program and live-in facility that Flowers is enrolled in.

The Governor recognized this too, highlighting the number of lives lost last year in Virginia to opioid overdoses.

“We lost 1,227 Virginians to opioid overdose. We know what the cause are, we know how to treat these individuals but we need the resources to really help them,” he said.

Resources that could help Virginians, like Flowers, continue to stay on track. Her recovery programs ends in about 15 days. Flowers is looking for housing, so her 6-year-old grandson can stay over for the night.

Flowers has been clean for 45 days and relieved she can get better coverage for her health.

“Everyday that I get up, you know, I’m like that’s another clean day that I got,” she said.

A few things still need to be approved for the program, such as the 1115 Waiver. This waiver gives states more flexibility with how to implement their Medicaid programs. Virginia is trying to create a work and or community engagement requirement as part of the health care coverage.

There is still an open comment period until Saturday, October 20, before everything is sent to the federal government for evaluation.

Click here to see if you’re eligible for coverage under the Medicaid expansion. 

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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