Catch-22s pervade Medicaid system

NEW YORK -- Cynthia Salomon was seven months' pregnant when her husband, Jose Lazo, was diagnosed with testicular cancer. It was Jan. 8, their daughter's second birthday. They had three jobs between them -- he cooked in two restaurants, she answered the telephone in a bank. But by Feb. 3, after his first operation, she was just another applicant for relief and Medicaid at the East End Income Support Center.

Cynthia waited for hours at the Manhattan welfare center, only to be sent home to call for an appointment. She called 15 times a day to get through. She submitted hospital records, rent receipts, birth certificates and bank statements, dealing with caseworkers trained to push people to work.

But by late April, when their second daughter was born and Lazo underwent more surgery, they still had neither Medicaid nor rent money for their East Harlem apartment.

On paper, the family was eligible three times over for Medicaid, the federal and state health benefits program created more than 30 years ago for the very poor and the very sick. Even if they had not been close to destitution, Cynthia and the children were entitled to coverage under expanded Medicaid eligibility for pregnant women and young children.

The Patient Accounts department of Mount Sinai Medical Center, where the baby had been born April 25th with a broken clavicle, eventually referred Cynthia to REAP, the Resource, Entitlement and Advocacy Program, founded eight years ago by the hospital's auxiliary. The program wages a kind of rear guard action to capture not just Medicaid payments for the hospital, but every government benefit available to those who come to its storefront office on Madison Avenue and 97th Street.

Over several weeks, Penny Schwartz, the director, and Ydelina Reyes, one of the program's eligibility specialists, spent up to three hours a day calling administrators at the welfare center and city Medicaid offices on behalf of Cynthia and her family, they said. But the computers kept spitting out rejections.

Schwartz finds it hard to convey to outsiders the Catch-22s of the system. For example, unemployed parents can rarely prove poverty to the satisfaction of the Medicaid system until they get public assistance, she said, because Medicaid requires income documentation like a welfare check or pay stub to show how expenses are met. Welfare system computers do not allow more than one change to be made to a case each day, so that when Cynthia gave birth, caseworkers deducted a $50-a-month pregnancy allowance from the welfare grant the family had never received, and did not add the new baby.

By June, Lazo's hospital, Memorial Sloan-Kettering, was losing patience. He was scheduled for re-admission June 16 for chemotherapy and an expensive bone marrow transplant. The hospital financial department ruled that unless his Medicaid enrollment was completed by then, providing him a number that could be used for billing, his admission would have to be delayed.

"June 13th we were at home crying, thinking, `Oh my God,'" Cynthia recalled. "If he doesn't get the chemotherapy, the doctor said the cancer would kill him."

The crucial Medicaid number was activated later that day. "It was nerve-rackingly close," said Schwartz.

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