Republicans Call Medicaid Rife With Fraudsters. This Man Sees No Choice but To Break the Rules.

Missoula, Mont. – While the Republicans of the Congress finalized the work requirements of Medicaid in the budget bill of President Donald Trump, a man who relies on this health coverage subsidized by the government tried to cajolate his old car to start after an eight -hour transition making sandwiches.

James asked that only his second first name be used to tell his story so that he does not lose health coverage or be accused of MEDICAID Fraud. He found his food service concert for a few weeks in a drug addiction treatment program. The man at the end of the thirties said that his boss “had not been disappointed.”

“I am a good worker,” he said with a smile.

James can obtain prescription drugs that help him stabilize his life and maintain this job through Medicaid, the national insurance-insurance program that covers low-income or disability. These drugs limit his desire for alcohol and deal with long -standing conditions that exacerbate his dependence, including bipolar disorders and insomnia.

But he has not qualified for the program for months, since his working hours increased and he received an increase of about $ 1 an hour. It exceeds its income eligibility limit of approximately $ 21,000 per year of around $ 50 per week.

James said that despite his increase, he finds it difficult to cover routine spending, like keeping his car walking and paying his phone bill. He said he could not afford the care he needed, even on the cheapest insurance scheme at his disposal via the affordable care law market or through the health insurance plan. Even pay $ 60 per month for his sleep drugs – one of the six prescriptions he takes daily – is too expensive.

“I only saw one option,” said James. “Fudge the figures.”

James did not report his new revenues to the state. This contradicts him with the Republicans of Congress who justified the addition of obstacles to Medicaid by affirming that the system is plagued by waste, fraud and abuse. But James is not someone sitting on his sofa by playing video games, the type of lecturer in the Mike Johnson room and other people said they would aim because they were looking for work requirements.

Medicaid offers health and long-term care coverage to more than 70 million people in the United States. Those who study security systems say that it is extremely rare for registrants to commit fraud to exploit this coverage. In fact, research shows that bands of eligible people are not registered in Medicaid, probably because the system is so confusing. And almost two thirds of people on Medicaid in 2023 had jobs, according to an analysis of KFF, a non -profit information organization of health information which includes Kff Health News.

Medicaid transitions can be eligible for other subsidized or low -cost health plans thanks to the affordable care law market. But, as in the case of James, such plans can have gaps in covered care, and more complete private plans can be too expensive. Thus, James and an unknown number of other people find themselves taken between working too much to qualify for Medicaid, but win too little to pay their own health care.

James considers himself a patriot and said that people should not “use government funding to be simply lazy”. He agrees with the republican argument that people should work if they receive Medicaid. Casting his hours of work from the government disturbs him, especially since he thinks he must lie to access the medical care that allows him to work.

“I don’t want to be fraud. I don’t want to die,” said James. “It should not be the only two options.”

On July 4, Trump signed the bill on the main taxes and expenses that made it more difficult for low -income workers to obtain Medicaid. This includes the requirement of beneficiaries to work or go to school and add documents to prove every six months that they meet a minimum number of hours at work.

“It will hurt people, whether or not they conclude according to the rules,” said Ben Sommers, health economist at Harvard University. “We see this broadcast of people for the most durable who really have trouble and who benefit from a program that helps them stay alive.”

James said he had initially refused his increase because he feared losing Medicaid. He had already been launched from the coverage about a month in his rehabilitation program after finding work. To stay in the sober program to live that he could otherwise not afford, he said James, he dropped just enough working hours to reshuffle for Medicaid, then quickly picked up hours. If he didn’t earn more, he said, he had no chance of saving enough money to find accommodation after graduating from the treatment program.

“They will give you a bone if you stay in the mud,” said James. “But you have to stay there.”

This problem – become just Successful enough to suddenly lose Medicaid – is common. This is called an advantageous cliff, said Pamela Herd, who is researching government aid at the University of Michigan.

“It simply makes sense that someone gets a dollar salary increase and all of a sudden, he loses all access to his health insurance,” said Herd.

She said that a partial solution exists on continuous eligibility, which guarantees the coverage of an individual’s Medicaid for a specific period, like a year or more. The goal is to give people time to adapt when they earn more money. Continuous eligibility also helps to maintain the coverage of low -income workers with unpredictable hours and whose wages changes from month to month.

But the congress has evolved in the other direction. Under the new law, political decision -makers limited valid adult eligibility windows every six months. This will put more people on the program’s admissibility cliff, said Herd, in which they must decide between loss of access to coverage or hours of lower at work.

“It will be a nightmare,” said Herd.

These federal changes will be particularly difficult for people with chronic diseases, such as James in Montana.

Not so long ago, James would not have broken the rules to access Medicaid because his condition had a continuous eligibility of 12 months. But in 2023, Montana began to force the registered to report any change of income within 10 days.

James is proud of how far he came. About a year ago, his body was decomposed. He couldn’t hold a spoon to have breakfast without whiskey – his hands were shaking too hard. He had crises induced by alcohol. He said that his memories of his most unhealthy moments come in flashes: to be put on a stretcher, the face of a worried owner, ambulance lights in the background.

James is recently graduated from his treatment program. He stays with a parent to save money because he and his girlfriend try to find an affordable place to rent – although even with Medicaid, finding accommodation looks like a section for him. He takes part -time lessons to become an approved addiction advisor. His dream is to help others survive dependence, and he also considers this career as a way to get out of poverty.

For James, all his progress move to keep Medicaid a little longer.

“Whenever I receive a piece of mail, I am terrified that I will open it and it will say that I no longer have Medicaid,” he said. “I am constantly afraid that it will disappear.”

In mid-July, officials had not noticed the additional $ 50 he won every week.