Donna (not her real name) called our office in tears because she had lost her Medicaid coverage. Donna was worried because she wasn’t able to afford her prescriptions without her insurance and felt the stress of it all might cause her to relapse on alcohol. Donna was referred internally our Health Coverage Guide for help with her insurance coverage issues. She was referred externally to Alcoholics Anonymous, her social support system, and declined further substance use referrals.
Our Health Coverage Guide worked as a liaison between Connect for Health Colorado, it’s online system, and Donna. It turned out that there had been a system error and that Donna’s income and household size was incorrectly recorded. Due to the timing of this error, she did experience a lapse in coverage and was referred to our Navigation team for care coordination services. Our team collaborated with the local pharmacy to receive a cash discounted rate on Donna’s monthly prescriptions, and also provided Donna with pharmacy vouchers as direct financial assistance to receive her medications while her insurance issues were being sorted out.
Through continuing efforts, calls, follow up, and outreach to both Donna and the Connect for Health Colorado helpdesk, the system error was resolved after a two-month long process. Donna was approved and was once again eligible for Medicaid. She remains in contact with our team for further care coordination support should she need it.
