This month, RMHF is shining a spotlight on the critical work being done by Legal Aid Justice Center (LAJC), an organization that partners with communities and clients to fight for racial, social, and economic justice by dismantling systems that create and perpetuate poverty.
Michaela Lieberman Martin is LAJC’s Senior Supervising Attorney with the Health Justice & Public Benefits Program. She recently shared with us the story of Adam*, a Virginia resident who suddenly and unlawfully lost his Medicaid coverage, the toll it took on his family to get it back, and how the recent passage of the “One Big Beautiful Bill” Act (OBBBA) threatens to harm those most in need.
Adam’s story began in 2021. After a long hospitalization for several surgeries, including to get a pacemaker and defibrillator implanted, and with multiple disabling conditions including congestive heart failure and atrial fibrillation (AFib), Adam and his wife were relieved to find out that he would finally qualify for long-term, facility-based care through Medicaid.
For two years, Adam benefitted from this lifesaving program; his wife was able to become his home-health aid, she was paid through Medicaid, and he was able to stay in his home.
Adam’s wife had to leave her job, but thanks to Medicaid, they were able to rely on her income as Adam’s caregiver.
Then, in 2023, Adam’s wife turned in their Medicaid renewal packet. Soon after, they received some troubling news.
“With no notice, they discovered that Adam no longer qualified for the program,” Martin recalled. “His wife stopped getting paid. The state had incorrectly processed his Medicaid renewal, and he lost the services he and his wife had been relying on for two years.”
This was the beginning of an arduous, years’ long process that Adam described in painful detail.
“It almost killed me first,” he said over the phone.
Adam and his wife got to work immediately, contacting the Virginia Department of Social Services (VDSS), filing an appeal, and requesting an administrative hearing to correct the error.
The Hearing Officer from the Virginia Department of Medical Assistance Services (DMAS) determined that Adam was indeed correct: DSS had processed his information incorrectly and his Medicaid services should have never been cancelled.
The Hearing Officer’s solution was straightforward: direct DSS to reevaluate Adam for the same services through Medicaid.
“This is a very complex system with lots of different players here,” Martin said, describing how interactions between multiple agencies and departments regarding overlapping programs and services can cause confusion and lead to unintended oversights. “It’s a systemic problem.”
But unintended or not, the impacts on regular people in need are all too real.
“In these situations, caregivers end up performing work that Medicaid is no longer paying for,” Martin explained. “Then people can’t pay their rent, and then they get evicted.”
For Adam and his wife, the impacts were only getting worse.
Due to another mistake, Adam was reevaluated based on the wrong criteria. As a result of this erroneous reevaluation, the Virginia Department of Health (VDH) was notified, which led to additional difficulties.
At this point, it had been 4 long months since Adam had received services or care through Medicaid. His wife hadn’t been paid either, putting the family at risk of losing their home.
“They put so much pressure on me and my wife,” Adam recalled. “Couldn’t they just do the right thing?”
Adam shared that while his wife was struggling with constant pain and taking care of both himself and her sister, she was fighting her own cancer diagnosis.
“But she never complained,” he said.
With nowhere else to turn, Adam and his wife turned to the LAJC, where Martin took their case.
“After losing two additional appeal hearings, we sought judicial review through a petition in a Circuit Court,” Martin explained. “We asked a judge to review everything that had taken place in the administrative hearings.”
But before the judge was able to rule or hear arguments, the LAJC was able to reach a settlement with the state that restored Adam’s Medicaid services.
But even that process dragged on. While Adam and his wife fought to restore his Medicaid services, he had been quietly disenrolled from one of the organizations that helped manage his care; care that had been paid for through Medicaid.
But even though it took several additional months to finally restore his services and close out the case, the family was still elated.
To celebrate, Adam and his wife hosted a party with family and friends and made sure to invite Martin.
“Everything was wrapping up,” Martin remembers. “They’d gotten their back pay. Then the night after the cookout, Adam’s wife died of an aneurysm. He’d said ‘the stress is killing us,’ and he was right.”
“They put my wife through so much,” Adam said over the phone. “So much physical and mental pressure. Now here I am. I’ve lost my wife. They just strung us along, and the stress was too much.”
For Martin, she worries what the passage of the OBBBA will mean for others who are in a similar position as Adam.
“Even when the system is working well, this is what can happen,” she said. “It’s already an incredible burden on people, especially those with extraordinary needs and disabilities. Then layer on cuts, requirements, no additional support technology, and imagine what it’s going to be like.”
Martin went on to explain that because the new law increases how often people need to submit renewals for Medicaid coverage while also defunding agencies and tacking on impractical work requirements, the country has invited a whole new host of problems.
“The frequency of renewals is going to increase the amount of time people have to show just how damn destitute they are,” Martin said. “It’s also going to increase the frequency of times someone can make a big mistake. It’s a very dark moment.”
As for Adam, while he’s grateful to have gotten his Medicaid back, he’s fearful about the future.
“I don’t even know if I’ll be able to keep my house,” he said, his voice cracking. “They put us through it, and I’ll never forget it until my last breath.”
And yet, despite his challenging circumstances and the overwhelming grief he continues to endure, Adam was resolute.
“I wouldn’t want anyone to go through what we went through,” he said. “Don’t give up. If you don’t fight them, you won’t have what you need. So you might as well stand up and fight.”
*The client’s name has been changed in the interest of privacy