Health-care stories: The search for contraception

Filed Under: Costs, Health plans, Patients

We’re inviting people to share their stories of the health-care marketplace. Here’s one, as told to Juliet Linderman. Here’s the first.

Liz, 25, Medicaid then Family Health Plus

When Liz neared the end of her graduate studies in early 2010, she didn’t have a job lined up right away and made sure to visit her gynecologist to get a 12-month prescription for birth control. Months after graduation, she still hadn’t found a job, so she filled out a general application for welfare, which included food stamps, Medicaid and cash assistance. She was quickly approved, and received an ID card. Several weeks later, she was notified that she had been accepted for Medicaid as well.

Unfortunately, Liz could not find any information about participating providers, and had to call the benefits office for details. They were difficult to reach, and their voicemail boxes were always full, making it impossible to leave a message. When she finally got through, the receptionist told her that her food stamps card doubled as a Medicaid card.

Shortly thereafter, Liz tried to purchase birth control pills with her Medicaid card. She had been buying the pills from the student medical center, but the center would not accept Medicaid. Instead, Liz decided to try and buy her pills at Duane Reade. She was told that although her 12-month prescription had been issued seven months earlier, she could not use her Medicaid card because it only covers prescriptions for six months. Liz went to Planned Parenthood and got a new prescription, for six months worth of pills.

A couple of months later, without warning, when she went to pick up her prescription she discovered that her Medicaid card was no longer valid. She called the Medicaid 800 number and after an hour was able to

speak with someone who told her she was no longer eligible for Medicaid on the basis of income she had recently reported, but that she was being considered for an alternative called Family Health Plus.

“They couldn’t give me any indication of how long I had to wait for approval and I had never received formal notification of this process, so they advised me to call the local benefits office where I had originally applied for more information,” she said. “Of course, no one answered the phone there, so I had to go in person. On my day off, I arrived at the benefits office first thing in the morning, knowing I would have to wait several hours to see anyone. When a caseworker finally called me to her desk, she told me that they didn’t deal with Medicaid at that site, and she had no idea what other welfare office did. This made no sense to me, since I had filled out all the paperwork and had my initial interview in that same office. But she refused to offer me any further guidance and I had to leave without any answers, having wasted half a day that I could have otherwise spent working or applying for jobs.”

Several weeks later, Liz received an approval letter from Family Health Plus, a plan for low-income adults who don’t qualify for Medicaid.

Soon after, she moved away from the neighborhood where she had been living, and tried to have her prescription transferred to another Duane Reade. Liz was notified that her new health plan didn’t allow the transfer of prescriptions from one pharmacy to another. She was forced to commute two hours to pick up her prescriptions. The first trip she made, the pharmacist told her it couldn’t be filled until the next day. She returned the next day, and was told that her prescription was six months and several days old, and could not be filled under her plan. Liz decided to pay out of pocket. In the meantime, she then had to wait weeks for another Planned Parenthood appointment for a new prescription.

“Every time I encounter one of these barriers, I’m astounded that the welfare system wouldn’t prioritize easy and convenient access to birth control for low income women,” she said.  “I’ve joked many times that it would be easier to just get pregnant and let the state foot the bill than it has been for me to reliably and consistently access birth control. The 6-month limitation on prescriptions is especially vexing, and I can only imagine how difficult it makes things for people with chronic or mental health conditions that make seeking out care physically or emotionally challenging.

“As frustrating as it was for me, I have a flexible enough schedule that I can wait long hours on the phone or in waiting rooms. Single mothers juggling multiple jobs and dealing with inflexible workplace policies and job insecurity can’t and shouldn’t have to make that much effort for the basic right to control their own fertility.”