Let’s talk about the Medicaid Cliff

The ‘Medicaid Cliff’ represents the tipping point at which some people find themselves at the very edge of income eligibility for the Medicaid program. In West Virginia, that’s 138% of the Federal Poverty Level (for an individual in 2021, that is $17,609 a year, for a family of two it is $23,792, for a family of three it is $29,974). 

For many people, Medicaid eligibility means the difference between health care that is almost free, and a monthly expense of $500 or more for private health insurance; or no insurance at all. When faced with the choice of keeping one’s health care and taking steps toward earning additional income--the financial implications for many West Virginian families are harsh. Some make the choice to go without health services that could improve the quality of their lives because they simply cannot justify the added health insurance cost. 

This month I got the opportunity to talk to Charles from Barboursville, WV. He’s currently working the nightshift at a plant in Cabell County and was kind enough to make time to talk to me about his experience on the edge of the Medicaid Cliff: 

Charles had been working part-time as a rural mail carrier for six years when the breaks on his truck suddenly failed on a winding gravel road in Milton, West Virginia. 

“I tried pulling it into the ditch line to stop it, but I couldn’t get it to go anywhere. So as it was going down I started opening the door.” 

In that moment he made the life-saving decision to jump out of the moving vehicle just seconds before it plummeted over the side of the hill. Charles escaped physically unharmed, but he was left shaken by the event. 

It messed me up because when I went back to work they had me on the same route again. It terrified me. I almost wanted to get out and walk down the road, I didn’t want to drive it.”

Based on his part-time income at the postal service, Charles qualified for benefits through Medicaid. This allowed him to see a therapist who helped him deal with his mental health in the aftermath of the accident. She worked with him to find an antidepressant that helped him manage his anxiety and enjoy time with his then six year-old son, who lives with him three days a week. After a month of taking this new medication, Charles felt things were finally looking up. 

Christmas of 2019 was just around the corner when it came time for Charles’s annual review to maintain his eligibility for Medicaid. He was asked to provide pay stubs for the weeks he worked between November and December--the busiest time of year for the United States Postal Service. Charles went from working his typical one or two days a week to working six days in a week during the holiday season. This sudden and temporary surge in income caused Charles to lose his medicaid coverage during that annual review. 

“I had been on it [the medication] for about a month and I felt great, and then I had to go and do that review and I lost my Medicaid. Then I had to take a month’s supply and stretch it out over the course of two months. One week I would take one every day, the next week I would take one every two or three days. And then so-on until I was only able to take one a week. Then I was out. It was terrible... My depression and anxiety were so high, I couldn’t function. To get up and do my fatherly responsibilities--It felt like I was trying to push boulders around.”

Charles knew he needed to take care of himself in order to be there for his son, and he was even willing to pay for his medication out of pocket. Then he learned that a month’s supply would cost nearly $500. He had no choice but to do without the expensive medication. 

I had to make do with what I didn’t have.”

Several months into the COVID-19 pandemic, Charles left his job with the Postal Service and moved from his secluded home in the woods to an apartment in Barboursville. He did this so his son would have a reliable internet connection and better access to his virtual classroom. At the end of 2020, Charles found a new job as a laborer at a manufacturing plant in Huntington, where he works the night shift. 

“I went in to apply for Medicaid just to see if my options have changed. I took a significant hourly pay cut as far as what I was making at the post office, but I’m working more hours. We work ten hour shifts, four nights a week. That’s just if we decide we’re not going to work over[time] that week. It’s typical for us to work 48 to 50 hours a week on the schedule. If I didn’t get paid every week I would almost be ok. If I only got three paychecks a month I’d do alright but when I get four of them, I make $400 too much to be able to qualify for Medicaid.

Like many West Virginians, Charles is experiencing the Medicaid “cliff effect”. He makes too much money to qualify for health care through Medicaid, but not enough to purchase a private  insurance plan. He would benefit from a new program that would give him the option to buy into a program similar to Medicaid with an affordable premium and copay limits. 

Charles says his priorities are all about being a good dad right now. Having access to regular doctors visits and mental health support would make that easier. 

I would really like to just go get a wellness check. Go from there. Make sure that I can keep up with the medications that I’m still on right now. The medication I take for my acid reflux, my suppression therapy medication, the things that I know I need….I want to take care of myself because I don’t want to be that sick old dad that my son has to take care of. I feel a lot of responsibility to stay healthy and make sure I’m doing well so he doesn’t have to worry about me.”


West Virginians are known for being strong. We are legendary in our ability to muscle our way through pain and hardship. But we shouldn’t have to. 

Charles, like so many West Virginians, could have his health care concerns addressed if he were able to enroll in a new program that would allow him to buy quality, affordable insurance that is similar to Medicaid - with low premiums and copay limits.  This program would give Charles and many other West Virginians the financial freedom to change jobs or take on more hours without losing his health care coverage. Delegate Evan Worrell (Republican - Cabell, District 18) is introducing a bill to create this program in this year’s legislative session. He understands the importance of giving thousands of West Virginians the real opportunity to take advantage of career opportunities and steps toward financial security.  Stay tuned for a bill number in the near future!

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