Using Medicaid to Help Uninsured Patients Afford Their Care

As the costs of cancer care increase and the burden of payment falls increasingly on patients, the role of financial navigators and advocate has become more important to patients’ psychosocial health. ACCC defines financial advocates as any staff member who has a role in providing financial navigation services to patients, including financial navigators, financial counselors, social workers, and pharmacy staff. These staff members can help ease the burden of treatment costs so patients can focus on their health and not let their finances be a determinant of the care they receive.  

One component of a financial advocate’s role may be to screen patients for Medicaid eligibility and help them apply for and understand their coverage. It is estimated that 1 in 5 Americans are covered by Medicaid. Cancer programs and practices may see patients who qualify for their state’s Medicaid program but have not applied. Knowing how Medicaid works and its application process is an important tool in any financial navigator’s toolbox. As a public health insurance program that generally covers those with low-incomes, families with children, pregnant women, older adults, and people with disabilities, Medicaid covers a large percentage of the oncology patient population. Because Medicaid rules and coverage may vary by state, financial navigators need to keep up to date on their state’s program.  

ACCC worked with members of the ACCC Financial Advocacy Network to provide guidance on how to help patients access much-need financial assistance regardless of their insurance status. Below, a financial navigator at Kettering Cancer Care in Kettering, Ohio, discusses how to help patients afford their cancer care if they are  eligible to participate in their state's Medicaid program. 

Helping Qualifying Patients Apply for Medicaid 
By Teri Brown  

I help patients at Kettering Cancer Care who are uninsured and qualify for Medicaid. For more than 32 years, I worked in the Greene County Department of Job and Family Services in Xenia, Ohio, which gave me experience and in-depth knowledge of Ohio’s Medicaid program. I have since taught other financial navigators at my cancer center the ins and outs of Ohio’s Medicaid program and how to help patients with limited resources apply to Medicaid to pay for life-saving cancer treatment.  

Patients come to our financial navigation program through many pathways: self-referral or through referrals from various members of the cancer care team, including our social workers, nurses, physicians, pre-certification staff, and schedule review staff. Once we determine that patients are not commercially insured and are eligible for Medicaid, our financial navigators contact them to discuss the circumstances leading up to their loss of insurance.  

After speaking to a patient, financial navigators complete and submit an online presumptive Medicaid application to the state of Ohio on the patient’s behalf. This enables our patients to be eligible for Medicaid coverage for up to three months on an emergency basis until the Ohio Department of Job and Family Services reviews their case.  

Most patients are approved to receive Medicaid immediately, and they are given a billing number. This enables patients to receive full healthcare services, including hospital, physician, dental, and eye care. Once our patients are granted this interim coverage, we help them complete a full Medicaid application that is reviewed by the local county office.  

The story below illustrates the value financial navigators can bring to patients.  

Once I worked with a young man who had been diagnosed with lymphoma. He did not have any source of income or insurance. He told me that he had previously applied for Medicaid but was denied. As I spoke to this patient, I learned that he is the father of two small children. The mother had both children signed up for Medicaid under her name, making her Medicaid-eligible as well. I asked the patient about his relationship with the children’s mother. He said it was “very good” and that they share parenting responsibilities. I let him know that, with shared parenting, both he and his children’s mother could place one of their children on Medicaid under their name, which would allow both parents to also be eligible for Medicaid. After this conversation, the patient spoke to the children’s mother, and she agreed to remove one of the children from her Medicaid coverage. My patient could then enroll one of his children into the program and qualify for coverage himself. The applications were approved, and the patient is now able to receive all hospital services without worry. 

Learn of more ways to help patients access financial assistance for their cancer care regardless of their insurance status.