Health care and homelessness

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Douglas and Anita “Annie” Gervais weren’t watching the big health care summit in Washington at their St. Paul apartment this afternoon. There’s not much they need to know about health care that they haven’t learned firsthand. And there’s nothing going on there that will save them from what’s going to happen here in the next 24 hours.

A couple of miles away from the Gervais’ apartment, the Minnesota Senate overrode Gov. Pawlenty’s veto of a bill that would extend a program providing health care to the state’s poorest citizens. The fate of the override effort in the House, however, is less clear. “If they would get out and see the people he (Gov. Pawlenty) is trying to shut the door on…” Douglas Gervais says, without finishing the sentence.

Annie has breast cancer. Douglas, who has had a kidney transplant, has mental health issues. They’d be wondering how they’re going to provide for themselves when MinnesotaCare cuts them off if they weren’t preoccupied with where they’re going to live after tomorrow.

Mrs. Gervais, 48, was a victim of the collapsing economy before the cancer moved in. She was an assembly line temporary worker at Colder Products Company in St. Paul until the hours started drying up last spring. “Finally, they didn’t call at all,” she said today. A few months later, she felt a lump in her breast. A mastectomy followed, and now she’s undergoing once-a-week chemotherapy.

“I put applications for work in, but that chemo really knocks me out,” she says. Her husband works as a building manager but his hours have been cut to about 10 a week. He’s trying to care for his wife, but his mental health issues have flared with every piece of bad news. He recently checked himself into the mental health unit at Regions Hospital.

“My nerves are completely shot. I have to work around her appointments,” he says. “When she’s down, I’m the caregiver. I’m a lunatic trying to care for her.”

MinnesotaCare has been providing coverage for most of the health care costs. Their $40 monthly premium had been cut to $16 and now to $8. “I’ve got the monthly bill here,” she says, “but I don’t have $8.”

She also doesn’t have the $720 rent payment that’s overdue. Last week, the couple went to court to learn that they have to be out of their apartment by Friday if they don’t come up with the rent, plus penalties, which now totals $1,145. The Minneapolis-based Angel Foundation, which provides financial assistance to cancer patients, helped pay last month’s rent but while it bought them some time, it didn’t buy an answer or a job.

“If we have to, we’ll live in the truck,” Douglas says. They’ll have to. Even if that’s a solution to their housing, it’s not a solution to their health care. “Look at all these medications we have to take. A $3 co-pay doesn’t sound like much, but it adds up pretty quick.”

They may qualify for free health care. Annie has an appointment with a Ramsey County financial aid worker on Friday morning. But most other efforts are stuck in a fact of life — it takes time, and the couple doesn’t have it. A disability application with Social Security hasn’t been processed yet and even if everything fall into place, the earliest they can get help is April.

(Disclaimer: The East Metro Adult Crisis Stabilization Partnership is trying to assist the Gervaises. My wife, Carolie, is one of the E-MAC team members on the case.)

  • Tricia

    Blech. This stinks on so many levels. What are these people supposed to do?

  • Bob Moffitt

    Plead guilty to a crime they didn’t commit? We provide health care for felons, but not for the Gervaises. (shakes head)

  • John

    Another window into the insanity that is employment based medical insurance. If you get sick enough, you can’t work and your health insurance goes away. How backwards is that?

  • Jeanne

    I have to wonder how many others with stories just like the Gervais are out there. This is a sad state of affairs in this country that there are so few jobs and no reasonable health care options. Live in their truck?! That has to be great for someone trying to get their health stabilized–whether that be physical or mental health. It’s wonderful that their are organizations like the Angel Foundation out there, but what is needed is a long-term solution: livable wage jobs and affordable health care. I’m sorry but citizens of this country, all of us, should be ashamed that we let this happen in the first place.

  • Minnwhaler

    I think Mr. Gervais has a great idea.. If only the folks making such harsh cuts could visit with those who are going to lose they might realize they could, but for chance, end up with similar issues. How can anyone survive a battle with cancer living out of a truck? I give this couple a lot of credit for telling their story. that alone takes alot of pride swallowing.

  • Kassie

    Terrible story, but not unfamiliar to me as a former county financial worker.

    They can go to a homeless shelter, but not together. There are no married homeless beds unless there are kids too.

    They can get section 8 housing, but it will take months before a place opens up.

    If they weren’t married, she could get General Assistance of $203/month, but his income (tiny income) will probably put them over the limit as a married couple. And Pawlenty is working to cut that anyhow.

    They will get food stamps. A lot of good that will do them with no where to be able to cook. I’m sure the variety of shelf stable foods that don’t require cooking is exactly what her doctor has ordered as a diet.

    We have this tiny little safety net that most people fall right past. And Pawlenty wants to eliminate it completely.

  • magnolia

    This is the heartbreak all around us. Can the lawmakers read? Do they think people are making these things up? So many other places on the planet take care of their own better than we do.

  • Adam

    All I have to say is this: These people are Lazy. There are MANY programs out there to help in these situations, and if you work hard enough you would be fine. It is their own fault that they wait untill the last minute to do anything to resolve their problems. Now they expect to have everyone else bail them out of the situation that they are responsible for. People want to pity them because of the situation they find themselves in, but I say do an audit. Even from the picture alone, I see new clothes, nice jewelry, nice glasses, people that are well kept. If you were in that desparate of a situation, move to a cheaper place, you have had more than enough time. Stop wasting money on even the small things. Sell the truck and take a bus.

    The reason these programs are losing funding is because they are being abused by for lack of a better description, con artists. People that dont deserve the benefits, but use them anyways. The only reason they are able to abuse the system is because they put in the work to do it. Think about it, if someone that doesnt deserve the benefits works hard enough, they will beat the system and get them. Why can’t these people that obviously deserve the benefits even put forth a fraction of that work?

  • Bob Collins

    //There are MANY programs out there to help in these situations, and if you work hard enough you would be fine

    Name one, Adam..

    //It is their own fault that they wait untill the last minute to do anything to resolve their problems.

    Chemotherapy and a nervous breakdown can really take up your time. Have you had chemo, Adam?

    //If you were in that desparate of a situation, move to a cheaper place, you have had more than enough time.

    If you don’t have the $8 for a health care premium, where are you going to move?

    //Why can’t these people that obviously deserve the benefits even put forth a fraction of that work?

    Let’s see if I follow you. The people who are putting effort into fraudulently obtaining benefits are working harder get a shout out from you because they’re hard-working con artists while people with cancer, a transplanted kidney, and mental health issues are lazy because they’re putting their energy into trying to stay alive? Those people are lazy but the people you’re suggesting as a model are abusing the system and that’s the reason why people like these people can’t get the benefits they legitimately could qualify for?

    That’s a little circular.

  • Grandma Julia

    I got sick to my stomach reading the comments from Adam. Hateful, ugly and unnecessary words. We should be pulling together to help this couple out, not trashing them because of unfortunate circumstances that conspired cancer, job loss, and now homelessness.

  • Jeanne

    Adam it certainly is easy for you to stereotype and, I don’t know, invent your own story about them and their ‘lifestyle’. I would suggest you spend some time volunteering at a homeless shelter? a hospice? a mental health facility? By the way, there’s a seat reserved for you in a VERY warm place (and it ain’t Jamaica).

  • Heartsick

    Adam, I pray that you never face the loss of your livelihood, home, life, and sanity, as these people are. There but by the grace of go each of us. Blaming them for their unfortunate circumstances might distance you from accepting this fact, but it can happen to anyone.

  • Adam

    I do alot of volunteering, this is why this situation bothers me so much. I’ve seen the people that really are in need. I will tell you, they look a lot worse off then these people. they are people that starve to death. At least she has had ACCESS to medical help. There are many that don’t. As far as the homeless part, I’ve been there and thank God, im not there any more. I have a heart definitely to help people that are in need, but when you walk the streets and see people begging for money in rags so you give them money, take a look at their shoes once. I at one point played the same game a good portion of homeless people did, and that is to take advantage of people’s kindness.

    You don’t get into the situation that this family is in overnight, it happens over time. Why weren’t they taking the steps needed in the beginning? Also, a simple google search will show that in the quick lost there are apartments costing $475 a month. That is without even looking hard. You cannot just keep giving people handouts, it doesn’t fix the problem. You need to provide education so that they can become self-sustaining.

    You cannot be gullible. How do you know that the kidney transplant didnt happen 20 years ago and has no bearing on the situation? My mother-in-law and father-in-law are both individuals that have gone through cancer treatment. My father-in-law came back from pancreatic cancer, my mother in law went through the same situation as the woman in this article. Neither of them sat around waiting for handouts even though neither of them could work. What we are talking about is simply a mentality of letting everyone come and fix your situation instead of setting out to fix your own situation.

    Yes, i agree, my posts sound hurtfull and spitefull and uncaring, but I am a realist and I don’t just believe everything thats handed to me like a good little boy. I suggest that you dont either.

  • Bob Collins

    // You need to provide education so that they can become self-sustaining

    I don’t think you’re following their story. These people WERE self-sustaining. They had jobs. They got sick. I know that a lot of people think that everyone who’s jobless and/or homeless are just lazy people living off the system, but this is a blog that deals in reality — that the the line between having a home and being homeless is a pretty thin one and that quite often, it’s medical expenses and/or medical conditions that push families from one side of the line to the other.

    //How do you know that the kidney transplant didnt happen 20 years ago and has no bearing on the situation?

    Because I didn’t write the story just by looking at a picture they sent me. I talked to them and asked them questions. See those prescription bottles? Some of those are anti-rejection medication.

    Should they have “taken steps” earlier? They were. There’s a social services program at the cancer center. They were getting help and are getting help but there are all sorts of gaps in the safety net; it’s not quite as easy as you are making it sound.

    I’m not sure where you’re getting your information that these people have just “sat around and waited for people to come help them.” Where? She’s been — as near as I can tell — doing all the right things, making phone calls, visiting places, putting job applications in, getting chemo, and spending a day throwing up in the bathroom.

    He’s been adjusting his work hours around her need to get to the hospital, and his nervous breakdown.

    What EXACTLY is it — and don’t just look at the picture — that makes you think what we’re talking about here are people who aren’t putting up a fight?

  • Mrs. Newscut

    Adam… without help they will look a lot worse soon. There are no cash programs available for them so they aren’t conning anyone. They have NEVER needed assistance. And if you had a reporter coming to talk to you would you not put on your best clothes, even if they are cotton t-shirts, so that they would be seen as human?

    As for the plenty of programs out there…

    please send me your resource handbook because I must be completely unaware of them after over 10 years helping people through the “system”.

    And by the way, where in the post do you see a plea for help? It’s a story. It is happening to real human beings, everyday, everywhere, and somehow you comfort yourself because you used to be a con and aren’t now, but everyone else is?

    Bus fare? have you priced it? They have very little I mean very little income. Would you like to take a bus to chemo and home again?

    If they were eligible for cash assistance from the county, which they are not, they would receive a whopping $261/month. So there goes your idea of an apartment for $425.00.

    Just for a moment pretend your rent/mortgate, utilities and food are paid for… Where would your generous safety net income of $261 get you? And unfortunately the rent, food and utilities are not paid because his take home is just over that $261.

    Don’t forget to add in monthly bus fare:

    Adults

    (Ages 13-64)

    Local Fare $1.75 $2.25

    Express Fare $2.25 $3.00

    One way… 5 times a week, two way, for two = $190/month per person. Oops you just broke your bank.

  • Adam

    Well, Bob, I go based upon what facts I see. (By the way, i do note that you did not address why they are still living in an apartment that is beyond their means when they have had ample time to relocate.) I look at reality… Apartments don’t just evict you out of nowhere for non-payment, ecspecially if the last months rent was paid… by the way, i really hate being this guy, but if you insist that everything completely adds up, i will have to… She was 47 years old working as a Temp on a line job prior to her having chemo therapy. That fact alone refutes your altruistic claim that they were already self-sustaining prior to this medical disaster. Let me ask you this…How do they eat? Do they use his paycheck to buy food from the grocery store? Are they on foodshare assistance programs? Do they go out to Taco Bell? Do they eat at the Salvation Army soup kitchens? And you CANNOT ignore what you see simply in the photograph unless you are just trying to give people a skewed view of the situation. Look at the collar of his shirt. His is a big guy, if the clothes he was wearing were old because he couldnt afford new clothes, why isn’t there a hole or two near the collar… that is typically what goes first… Also, the shirt is a very dark black, typically after multiple washes the shirt would fade. Her clothes are the same, no holes, no fading, no tears. Im an individual that came from the street, and if me, being homeless at the time, were sick and saw that they HAVE the benefits that allow her to get chemo, that HAVE people paying their rent for them, i would be very put off..

    Im not arguing that these people have it bad, they obviously do. Im simply stating that their lives and situations up to this point have determined financially where they are currently at.

    My interest in this case is because an individual had made reference to ask why a certain company wasn’t providing these individuals with donations instead of another family that they had made donations to already that in my opinion were in a bit of a worse situation.

  • Bob Collins

    I’m sorry, Adam. I’ve got to disconnect from this conversation and maybe someone else will pick up on it. I just can’t spent a minute of my life arguing about a serious and complex issue based on a guy’s T-shirt looking new.

    These people are doing the best they can, they’re very sick, and they’re very scared. The way I was raised leads me to just one response, no matter how cynical I am — and trust me, I’m as cynical as they come.

    Take from that what you will, but I just can’t take myself where you are.

  • Heartsick

    Adam, I believe that you are talking about the TFFL wall post on Facebook. If you re-read the comments carefully, no one said anything about why TFFL wasn’t helping them. No one has asked TFFL to help them up to this point. The contrast was simply being made that things could have turned out so much worse and does for many people. TFFL is a fine institution and does much good in the world. The original family that you were referring to had purchased policies that covered their crisis. This family has no safety net and that was the other point being made.

    You are making judgments about people that you have never met based on one photo. I buy second hand clothing for $6.00/outfit that is as nice or nicer than what they are wearing. When one’s life crashes, it often happens very quickly. Unless you have walked a mile in their shoes, you should not judge them. We all fall short and don’t do all that we could.

  • Adam

    Like I said, I dont doubt that they are sick and are scared, and need help. my contention is just that you cant assume that everyone is completely noble and are now being completely victimized

  • Bob Collins

    This isn’t a story about everyone. It’s a story about two people. Neither noble, nor victimized appears anywhere in the post.

  • Jeanne

    Adam, did you get the memo that the Inquisition was over with a long time ago? Accusing someone of scamming because they don’t have holes in the collars of their shirts?! You can’t be serious. If you have a personal issue with an agency doing something you consider unjust, maybe you should contact that agency and speak with them about it. Don’t take your (misdirected) anger out on people who have done nothing to you. If there’s a chance, even the slightest of one, that your perceptions of them are wrong, maybe they’ll be more forgiving than you are.

  • Duke Powell

    Bob, I hope you can answer a couple of questioins.These are complex issues and I’m trying to understand this particular situation.

    According to your article, these two folks are enrolled in MinnesotaCare. Why are they losing their eligibility?

    Governor Pawlenty’s unallotment of the separate GAMC program is blamed as the cause of the Gervais’ health coverage problems. How can that be? They aren’t on GAMC.

  • Bob Collins

    //According to your article, these two folks are enrolled in MinnesotaCare. Why are they losing their eligibility?

    They haven’t lost their eligibility. As yet, they’re unable to make a premium payment, though I’m pretty sure someone’s going to come up with $8 somewhere. Their problem is less about health care than it is about homelessness.

    //Governor Pawlenty’s unallotment of the separate GAMC program is blamed as the cause of the Gervais’ health coverage problems.

    I don’t see where their problem is blamed on GAMC. From what I see their problem is the economy, the link of jobs to health care, and the thin link from home to homeless.

  • Heartsick

    One of the biggest problems that this couple will face is that even if Annie were able to find stable employment, Annie would have no sick time which is usually either accrued or available only after the probationary period. During a probationary period, if you miss too much work or sometimes any work, you lose your job. I would assume that the re-occuring need for time off has contributed to the loss of hours and eventual loss of employment for Annie. This is a very complicated situation with many forces working again this couple becoming stable without a lot of help.

  • Minnwhaler

    Duke, GAMC has a cap on prescription co-pays, max $7.00 per month. MNCare doesn’t.

    They have been paying for MNCare which only covers $10,000 for in hospital treatment of which the policy holder is expected to come up with 10% of. It also has a monthly premium which this couple can no longer afford. GAMC-Transitional MNCare is still available at no premium cost to clients who are income eligible. Minnesota Care’s surplus has been used to balance the budget and has been mentioned as the next to go for childless adults, along with the generous “Cash program” which pays that Whopping $261 per month for an eligible couple (mentioned by Mrs. Newscut) . When the working poor get sick they lose housing and soon they will lose health care coverage as well. I believe that is the link to the issue with unallotment mentioned by Mr. Collins. If those cuts are allowed to continue, we will be virtually signing the death certificates of countless people. Balancing the budget on the backs of the poorest of the poor is wrong from every angle I can see.

  • Duke Powell

    // They haven’t lost their eligibility. As yet, they’re unable to make a premium payment, though I’m pretty sure someone’s going to come up with $8 somewhere. Their problem is less about health care than it is about homelessness.//

    Well, I bet a lot of people were fooled then. Seven of the ten paragraphs dealt with their health problems, their inability to pay and a gratuitous slap at the Governor.for his GAMC unallotments.

    // From what I see their problem is the economy, the link of jobs to health care, and the thin link from home to homeless.//

    Except for the phrase “the link of jobs to health care” (their jobs didn’t provide health insurance they are on MinnesotaCare) I agree. The problem is lack of income.

    The good news is that it seems to me that Ms Gervais is eligible for Medical Assistance due to her breast cancer diagnosis coupled with their impoverished condition. As such, treatments, medications and transportation to and from appointments are essentially free. In addition, any unpaid medical bill for the previous three months will be paid by the State.

    There isn’t enough information in the post to make any guesses about Mr.Gervais’ options.

  • Duke Powell

    One last comment.

    If I’m reading the law correctly, Ms. Gervais has been eligible for Medical Assistance since her breast cancer was diagnosed.

    Why is she on MinnesotaCare?

    I don’t expect her to know this. But it seems that someone, somewhere along the way should have said, “Hey, wait a minute.”

    If she had been placed on MA, the Feds would have picked up half the costs of nearly all services required in her treatment. That would have saved the State a lot of money.

  • mnsaami

    I might have missed something in the comments above, but as to the apartment situation, anyone who has college aged children, or who has lived in apartments, knows that it takes a lot of money to move, with deposits for damage and utilities, even if the apartment will cost less in the long run. It’s also difficult to move if you have built a support network in your building, people who will check on you if you are ill, or run errand for you when you can’t. Also, many people with mental health issues end up not qualifying for apartments if their mental health issues have ended up in disruptive situations, or go into crisis. Rent applications require good references, which sometimes aren’t possible due to issues which crop up with mental illness.

  • Minn Whaler

    The breast cancer would have had to be diagnosed by clinics connected to the Sage Program which is the path to MA for breast cancer. Hers was discovered while on MinnesotaCare and no one told her that she possibly had access to MA. She still does, but it is via a SMRT (State Medical Review Team) and that process takes a couple months. the outstanding bills she has that MNCare doesn’t cover may then be paid by the feds. He has the same possiblity because he can’t work more than 10 hours a week. How long did it take you to find the law Duke? and how did you find it? I am guessing you have a computer and a knowledge of MN statutes and how to search policy, read it and understand it. But after you found that, did you find how to actually make it happen?

  • Duke Powell

    Minn Whaler,

    If you would have looked a little further, you would find that she is “presumed eligible” prior to being deemed eligible. She could have had MA coverage from the get go.

  • Carolie aka Mrs. Newscut

    Duke,

    I wish you would dircet me to that policy because according to MN DHS policy this is how one with breast cancer MIGHT be found eligible for MA and as for having coverage from the get go, she already had Minnesota Care which is “creditable coverage” and eliminates the possibility. Here is the policy as written on the DHS site: MA for Breast/Cervical Cancer (MA-BC) (Archive)

    Women who need treatment for breast or cervical cancer, including precancerous conditions and early stage cancer, may be eligible for Medical Assistance (MA) under the Breast/Cervical Cancer basis of eligibility (MA-BC) if they meet all of the following conditions:

     Have been screened by the Sage Screening Program: A free statewide comprehensive breast and cervical cancer screening program administered by the Minnesota Department of Health whose primary objective is to increase the proportion of low or moderate income age-appropriate women who are screened for breast and cervical cancer. and used program funds to pay for the screening.

     Need treatment, including diagnostic services to determine the extent and course of treatment for breast or cervical cancer, including precancerous conditions and early stage cancer.

     Are under age 65.

     Are not eligible for MA without a spenddown under any of the following bases:

     Parents/Caretakers.

     Children under age 19 who have a children under 21 basis of eligibility.

    Note: Children ages 19-20 who are eligible under this basis may be eligible for MA-BC.

     Pregnant Women.

     Blind or disabled receiving SSI who have income at or below 100% FPG and are eligible for the Disabled Adult Children disregard, Widow/Widowers’ disregard, or Pickle disregard.

     1619(a) or (b).

     Blind or disabled and receiving Minnesota Supplemental Aid (MSA).

    Note: A woman who is eligible under one of these bases without a spenddown, may not be enrolled in MA-BC. A woman who is eligible under a different basis than those listed above may choose between that basis and MA-BC.

     Are not covered by a creditable health insurance plan.

     Have an immigration status that qualifies them for federally or state-funded MA.

    She was not screened by the Sage program and she had creditable coverage. Presumptive eligibility went the way of many other programs over 5 years ago (according to DHS). If that is not the case please provide us with the law you are quoting.

  • Duke Powell

    Well, here it is. I’m always willing to be wrong, but the language looks pretty plain to me.I’ll tweet Bob the URL.

    Good Luck.

    256B.0637 PRESUMPTIVE ELIGIBILITY; TREATMENT FOR BREAST OR CERVICAL CANCER.

    Medical assistance is available during a presumptive eligibility period for persons who meet the criteria in section 256B.057, subdivision 10. For purposes of this section, the presumptive eligibility period begins on the date on which an entity designated by the commissioner determines, based on preliminary information, that the person meets the criteria in section 256B.057, subdivision 10. The presumptive eligibility period ends on the day on which a determination is made as to the person’s eligibility, except that if an application is not submitted by the last day of the month following the month during which the determination based on preliminary information is made, the presumptive eligibility period ends on that last day of the month.

  • Duke Powell

    BTW, Carole, on the “creditable coverage” issue–If DHS refuses to place Ms. Gervais on MA because MinnesotaCare is deemed “creditable” then someone needs to get yelled at.

    It is the stated goal of DHS to push as many people as possible onto Federal programs where Minnesota only pays half the costs. If she stays on MinnesotaCare the cost will be fully borne by the Health Care Access Fund.

    MinnesotaCare has a $10,000 yearly limit on inpatient services and $100,000 yearly limit on outpatient. I don’t know when the mastecomy was but, depending on the treatment therapy chosen, she could easly bump up against these limits if she develops complications.

    MA is better for her and better for the Minnesota budget.

  • Carolie

    Thanks for the info Duke, but notice presumed eligible if meets the criteria in section 256B.057, subdivision 10, which she does not. And yes there are many things to yell about, but changing the path to MA for someone already on MN Care is quite timely and I agree…. someone, somewhere, should have jumped on this boat way back at her diagnosis, but they didn’t. I just met her 3 weeks ago. We have taken all the steps we can to change the health care coverage to the more appropriate federally funded MA, but as I indicated above. It just isn’t as simple as the law appears. BTW, presumptive eligibility begins at a clinic enrolled in the Sage program when the diagnosis is made and yes MNCare is considered creditable coverage for that program and so she missed out on two of the 3 essential criteria for MA. Let’s throw out the MN health care program policy manual and start over! It is over 800 pages long.

  • Rob Levine

    Great reporting. One alternative to atheism is the theory of a cruel god, which this story certainly supports. And cruel governor, to boot.