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“Now I Can Afford My Meds.” After Months of Appeals, Retiree’s Medicaid Benefits Are Restored.

South Carolina’s Medicaid agency abruptly and unexpectedly canceled Judith Persutti’s insurance in 2019, but reinstated it following a little-used appeals process.

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Almost two years after Judith Persutti first applied for Medicaid in South Carolina, the 64-year-old retiree who gets by on Social Security and food stamps had her health insurance restored Friday.

Her benefits were reinstated after ProPublica examined a little-used appeals and hearing process that allows people receiving public assistance to challenge adverse decisions made by government agencies. The Trump administration has called the right to appeal a “guardrail” that protects citizens as states try to apply more stringent requirements for Medicaid, the state-federal health insurance program for the poor and disabled.

Few people file appeals, but Persutti did. Appearing without a lawyer, she showed up in February in Columbia for a one-hour hearing that dissected in detail her medical and work histories to determine if she is disabled, unable to return to work, and qualifies for Medicaid.

The South Carolina Department of Health and Human Services “made previous errors when starting and stopping [Persutti’s] coverage,” the presiding hearing officer, Colleen Clark, wrote in the final administrative decision. Even though the state determined that Persutti was last employed as a “sedentary telephone customer complaint clerk, she cannot perform it due to the presence of occasional climbing, stooping, reaching, or bending present in the occupation. She has a severe impairment.”

“Now, I can afford my meds. I can afford the things I need,” Persutti said after receiving the final administrative order. “Hopefully, this’ll open people’s eyes. Maybe the road that you have to travel to get to this point, maybe make it less difficult.”

South Carolina is one of 14 states that declined to expand Medicaid under Obamacare. It embraced the Trump administration’s work-requirement initiative to make it harder to qualify for Medicaid, which cost the state about $7.7 billion in 2019 — or about 17% of its budget.

Amid the COVID-19 outbreak, new federal laws say states can’t kick someone off Medicaid or make enrollment more difficult (such as by imposing work requirements) until the public health emergency ends. Anyone enrolled in South Carolina’s Medicaid as of March 18 gets to keep it for now, according to the state.

South Carolina’s Department of Health and Human Services said in a statement Tuesday that it closed local eligibility offices to walk-ins but is maintaining normal business hours and opened its call center on Saturdays so people can “complete any action” they would normally do in person. On Wednesday, the state said it continues processing applications and appeals that were pending prior to the novel coronavirus outbreak.

Persutti’s letter arrived as she and her oldest granddaughter continued to shelter in place in her little house near the Savannah River.

Medicaid abruptly terminated Persutti’s health insurance in November, saying only that she did “not meet policy rules the rules for age or disability.” She appeared at her hearing just before the global pandemic erupted in the U.S., spreading fear as far as Persutti’s one-stoplight town.

As Persutti waited for a decision, a timeline she was told would be about 30 days, the novel coronavirus outbreak grew. She became one of the country’s 28 million uninsured adults, many with chronic illnesses that make them particularly vulnerable to the dangers of COVID-19.

Persutti has osteoarthritis and fibromyalgia, hypertension and asthma. She’s supposed to take a mix of prescription medications for pain, inflammation, blood pressure and anxiety, but she can’t afford them all.

Just over 1 million people are on Medicaid in South Carolina, which processes applications and eligibility reviews by the tens of thousands annually. Last year, according to the state, 3,711 appeals were requested but only 101 hearings were held.

The final order said Persutti has qualified for Medicaid since 2018 when she first applied.

“If I could, I’d be doing my little happy feet dance,” she said. “This has been such a long, rough, hard road.”

Kirsten Berg contributed reporting.

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Akilah Johnson

Akilah Johnson was a narrative health care reporter at ProPublica.

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