I applied for health coverage offered under the U.S. Affordable Care Act (ACA) in the fall of 2015 after my position was eliminated following a merger and reorganization.  I had been on COBRA briefly but at $900/month there was no way that I could afford it.  I had no income at the time and the ACA website informed me that I did not meet the requirements for ACA coverage but I did qualify for Medicaid.  My application was automatically forwarded from the ACA website to the State of New Jersey and after a few months of waiting for coverage, with no idea when it actually went into effect, I became an official recipient of public assistance in January 2016.

I was thrilled to have free health, dental, and prescription coverage as well as receive one pair of subsidized eyeglasses annually under Medicaid.  My first appointment was with an optometrist and my second a dentist – neither required me to work through my official Medicaid primary care provider (PCP) – and I could not have been happier.  Next up was my first appointment with my PCP and I wasn’t concerned at all because my health plan said that my existing PCP was an in-network provider.  So, I made my appointment as usual and when I showed up I was informed that my PCP did not see Medicaid patients at his regular office; I was told to call the Jersey Shore Clinic and make an appointment with him there.

After two days of trying unsuccessfully to reach the Clinic, the phone just rang and rang and rang without even an answering system picking up, I decided to go there in person to make an appointment.  The blinds were closed in front of the registration desk and this is what I saw:

No wonder no one ever picked up the phone!  As I had no other option because no one who worked at the Clinic was anywhere to be found in or around the waiting area, I filled out the form (picture on the left) and deposited it in the box (picture on the right).  I wrote the name of my PCP on the form and explained that I needed to see him as a follow-up to my last appointment with him.  Several days later I received a call from the Clinic to set up an appointment and in two weeks I went earlier than my given time in case I needed to do any paperwork.

My appointment was at 1pm.  I was the last person left in the Clinic when it closed that evening.  I spent all afternoon there, saw an intake nurse, went back to the waiting room, and about 90 minutes later I met with a resident who wasn’t even being overseen by my PCP.  The resident consulted with his attending mid-appointment because what I wanted (specific blood tests following a substantial weight loss to see if “my numbers” were normalizing; an order for a mammogram; and referrals to my surgeon, cardiologist, gastroenterologist, and dermatologist) would trigger red flags from Medicaid.  I waited about 30 minutes for him to return.  Then I was told to make an appointment to come back in three months and go to the waiting room, where I would be called to retrieve my test orders and referrals.  Over an hour later, when no one else was present in the entire establishment, I was finally called in to get my documents – I was given an order for the mammogram and very basic blood work, and referrals to a gastroenterologist and dermatologist; I wasn’t able to see my surgeon or cardiologist, nor were the blood tests that I actually needed ordered even though I presented the resident with ample justification for doing them.  I was supposed to return to the Clinic this month; I’m never going back.  Instead, I just paid $2000 (thank goodness for credit cards) for a year of student health insurance through the university at which I am presently engaged in doctoral study.  Anything has to be better than so-called “managed care” under Medicaid.

As someone who worked in academic health sciences for nearly 20 years, I have heard health care professionals, time and time again, sincerely wonder with their colleagues why people on public assistance go to the Emergency Department (ED) for non-emergent, primary care.  Well, I can solve The Great ED Mystery once and for all: require all health professions students to spend one year on Medicaid and they will never again ask that question.