When Marion Puglisi, 62, was prescribed a new medication to treat atrial fibrillation, she wasn’t sure how she was going to pay for it. The cost was staggering — $500 for a one-month supply — and she didn’t have health insurance coverage.
Puglisi was referred to MaineHealth’s MedAccess program and learned she was eligible for a prescription assistance program through the pharmaceutical company. With the help of MedAccess, she was able to get her medications for free; however, she still didn’t have comprehensive health insurance to cover her other medical expenses. To pay for medical appointments, she relied on Maine Medical Center’s Free Care program.
“I had been turned down by MaineCare for several years,” said Puglisi. MaineCare is the state’s Medicaid program that pays medical expenses for those with limited income. Even though she met the income requirements, she did not fit into one of the non-financial eligibility categories: families, people with disabilities, and adults aged 65 and older. Each time she was denied, she was told to apply for coverage through the Health Insurance Marketplace; but when she applied there for a private health insurance plan, she was told she didn’t make enough money. “I wasn’t qualifying anywhere,” she said.
In January 2019, Puglisi was among the nearly 70,000 Mainers newly eligible for MaineCare. Recognizing that this legislation would help more patients get the health care coverage they need, the Access to Care team jumped into action by offering in-person application assistance at community events. The team also visited locations across the MaineHealth system to educate patients and providers about MaineCare expansion and how to apply.
To help identify patients who could benefit from this new law, Access to Care collaborated with MaineHealth’s Central Billing Office and Financial Counseling teams. Now, when a patient applies for Free Care and appears eligible for MaineCare, they are immediately referred to the Coverage Team for assistance with applying to MaineCare and other programs.
Many applicants — like Puglisi — have used Access to Care programs and were previously ineligible for MaineCare due to their income. The Access to Care team has been reaching out to these newly eligible individuals to help them submit applications and obtain the best coverage possible.
With Puglisi’s permission, the team worked with DHHS to get retroactive MaineCare coverage back to July 2, 2018. “They took care of everything in the process,” said Puglisi.
Even though Puglisi had good experiences with Access to Care, she recognizes the value in having comprehensive coverage. “I feel much more secure now,” she said.