A Second Look at Medicaid: Why You May Qualify Today

In this episode of Vitals & Voices, we sit down with Vanessa Strong and Sandra Carvajal, Financial Counselors at Lexington Regional Health Center, to discuss Medicaid eligibility, changing income situations, and what local families need to know as our community continues to navigate the impacts of the Tyson closure and other employment changes. They explain why a previous Medicaid denial doesn't necessarily mean you're ineligible today, how income changes can affect eligibility, and what steps people should take if they've recently lost insurance or received a letter from DHHS.
Vanessa and Sandra also break down Medicaid work requirements, explain how LRHC's Financial Counseling team helps patients navigate applications and paperwork, and share practical guidance for anyone feeling overwhelmed by the process. Whether you're uninsured, facing changes in employment, or simply trying to understand your options, this episode provides clear information and valuable resources.

What You'll Learn in This Episode:

• Why Medicaid eligibility can change when your income changes
• Why it's worth reapplying even if you've been denied before
• What to do if unemployment benefits are ending
• How to respond to letters and requests from DHHS
• What Nebraskans should know about Medicaid work requirements
• How LRHC Financial Counselors can help with applications, paperwork, and questions
• What the Designated Authorized Representative (DAR) form is and how it can help patients navigate the process more easily

Why This Episode Matters:
Health insurance can be confusing, especially during times of job loss, income changes, or uncertainty. Many families may qualify for assistance they didn't qualify for in the past, but they may not realize it. This episode serves as a reminder that help is available, questions are welcome, and no one has to navigate the process alone.
If you've recently lost coverage, experienced an income change, or received a Medicaid-related letter that you don't understand, this conversation is an important first step toward finding answers and accessing the care you need.

Vitals & Voices is a podcast powered by Lexington Regional Health Center, offering meaningful health conversations that matter to you. Each episode features authentic stories and expert insights from the people behind the care — including healthcare professionals, wellness advocates, community leaders, and patients — all aimed at helping you live your healthiest, most informed life.

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Transcript

SPEAKER_02 0:07

Hello and welcome back to Vitals and Voices. Today's topic affects hundreds of families right here in Lexington and Dawson County. Maybe you've recently lost employer-sponsored health insurance, maybe unemployment benefits are ending, or maybe you've applied for Medicaid before and were denied. Maybe you've received a letter from DHHS and aren't quite sure what to do next. The reality is that Medicaid eligibility can change when your income changes, and many families have new opportunities that maybe they didn't have a few months ago. We're hearing questions about work requirements, reporting income changes, and how Lexington Regional Health Center can help you navigate this process. So to help break it down, I am joined by two people who work very closely with these situations. They are our financial counselors. Welcome, Vanessa and Sandra. Thank you for having us. So let's just start with the big picture. Can you tell us what you're seeing locally here as our community continues to navigate the impacts of the Tyson closure and just changing employment situations?

SPEAKER_00 1:04

Yeah, so people don't often realize that they can qualify for um Medicaid. They um what we're seeing a lot right now is um people being denied for over income. Um, but they are not aware that as soon as that changes, they can come in and we can reapply for them and start the whole process over again with them. So um I just want people to know that there are options for them and um we're here to help.

SPEAKER_02 1:37

Because would you say so the Tyson closure was beginning of January? A lot of families at that time applied for unemployment. And that's only a certain amount of time. To apply for unemployment? That you can get that unemployment benefit.

SPEAKER_00 1:53

Yes, yes. Um they had um roughly was the August-ish for it to be there.

SPEAKER_02 2:00

And so now that we're hitting, I mean, end of summer here, those families are losing in unemployment, most likely.

SPEAKER_00 2:09

Right. It's going to be coming to an end for a lot of people. And so that income change can be very helpful for their future application.

SPEAKER_02 2:20

So are you saying that a lot of people, I mean, are surprised that, you know, maybe they tried to apply for Medicaid January, February, they got denied, but that they're able to apply now?

SPEAKER_00 2:31

Yes. Yes. Um, with, like we said, like with this income change that's going to be coming, um, we advise a lot of people to come in and get that um rechecked, that income rechecked.

SPEAKER_02 2:44

So tell me what that looks like. If you know of that income change, what is kind of that next step or what does somebody need to have to come to come and see us?

SPEAKER_01 2:54

Yeah. Um They'll probably need some verification stating that it is at an end, if that's a screenshot or something. Ideally, DHS should be able to pull that it is at the end. Okay. But just for safe measures, just bring that proof of identification and then be able to reapply for them.

SPEAKER_02 3:12

Okay. I mean, that's just great to know that families should, I mean, try it. And what's the worst I can say? No.

SPEAKER_00 3:20

I mean, just trying is always the best. I mean, people sometimes are like, I'm not, I know I'm not going to qualify, but do you actually really know? Like, let's just give it a try and see.

SPEAKER_02 3:30

And is it a, I mean, a new application they're submitting? Are they adding it to maybe a previous denied application? What does that look like?

SPEAKER_01 3:38

It'll it'll probably be a new one just okay because the time has um lapsed.

SPEAKER_00 3:42

Yes. Once once they're denied for an over income, that application is closed and we have to start over.

SPEAKER_02 3:48

Okay.

SPEAKER_00 3:49

With a new recent one.

SPEAKER_02 3:50

And is that something I know, I mean, technology, there's I mean, so many different applications or things these days and age. Is this something that you both of you ladies can help patients with if they need help applying? Is that, I mean, that part of your daily routine?

SPEAKER_01 4:03

Yes, absolutely. I mean, that's I think we take pride in that part too. We're taking a really complex system and simplifying it. So we are helping our patients apply for it. We created a Microsoft application system that allows us to track our patients as they're going through this application process. So it really is hands-on and we get to help them through the whole thing.

SPEAKER_02 4:24

So I'm just thinking, you know, patients that were maybe over income via unemployment. Do we believe that some of these people have been without health insurance for a while?

SPEAKER_00 4:35

Yes. Yes, we have. And we've seen a lot of patients where that denial is coming in and they're pretty much, they do have the option to apply for marketplace, but um, they're being denied for over income. And by that we mean $100, $200. So sometimes marketplace is not an option for them. It's more expensive to get marketplace than to have, you know, that have it health insurance.

SPEAKER_01 5:01

And then marketplace comes with deductibles, co-insurance, co-payments, max out of pocket. It's a whole different ballgame. So we did help a couple patients that needed, if they need surgery or they they have no other choice, then we move to that level.

SPEAKER_02 5:15

It's just scary to think about. And it's just, I mean, so amazing to know that you ladies are here to help and that to give, I mean, I think a message of hope to our community of, you know, if you haven't been able to find a job, whatever your circumstance is, we want to get your health taken care of. Yeah. And they're not alone in this. Like they're not alone, right? I mean, our whole, I mean, our whole community.

SPEAKER_00 5:36

Yeah, our whole Lexington community has come together in this hardship with Tyson, with Tyson closing and everything. Um, I feel like our community really showed up for everybody.

SPEAKER_02 5:47

I agree. It's cool. It's cool to see. So DHHS sends a lot of letters from my what I hear. Talk to us about, you know, if a person receives a letter regarding their Medicaid, maybe what some of those letters might entail, what they need to do, or how you guys can help with that.

unknown 6:07

Yeah.

SPEAKER_00 6:07

So we have the system where if you do receive a verification request or receive a letter that you're just don't know what you're needing, what to turn in, we advise to call in the clinic, make an appointment, or drop off the paperwork. If you're a patient that we're working with right now and you don't have time to come to an appointment, we advise just dropping off the paperwork, leaving your information with the girls up front. That way we can um reach back out to you and see how we can assist and when you're able to come in and bring that paperwork that's needed or whatever it is that's needed from them.

SPEAKER_02 6:41

Because Vanessa, would you say that, I mean, not every letter you're going to get from DHHS is a denial. Sometimes they just need more information.

SPEAKER_01 6:49

Correct. Yep. A verification of somebody else in the household's income or different things like that. Okay. And then sometimes the patients don't understand what it is. I mean, we could understand it. You need baked statements, but for them, they may not understand why or what's going on. So it's it's really helping them understand that due diligently.

SPEAKER_02 7:11

Especially if it's in another language, too, as well. Are most letters via Medicaid English?

SPEAKER_00 7:17

Well, some of them do come in in Spanish, depending how it's the application's filled out. If we know that the patient is Spanish only, we do put that on the application. That way the paperwork that they're receiving is on their language.

SPEAKER_02 7:29

Okay. Okay, that's good to know. Yes. So I know in the news or various outlets, I've heard about the Medicaid work requirements. Talk to us about, I mean, what's coming with that? What does that mean?

SPEAKER_01 7:41

Yeah. So that'll affect anybody who's 19 to 64. Okay. Yep. And if if you're pregnant, not you. And if you have Medicare, also not you. Okay. Um, but the work requirements will be that you have to work 80 hours a month. And if you're not working, you have to show that you have community or volunteer hours. You can have a work program, you can be in school half the time, or you can be receiving an income of $580 a month, which is the federal poverty level for that month.

SPEAKER_02 8:14

So I know here in Dawson County with the Tyson Closure, talk to us a little bit about how maybe that's little those work requirements currently aren't in place for our county.

SPEAKER_00 8:26

Yeah. So since we did have that Tyson closure, our unemployment rate is very high. So right now, for the time being, Dawson County, those rules don't apply to us here in town. Um, but in the future, and that's why we want to just give people a heads up so they know what's coming. We don't necessarily have a date on when that's going to be lifted, but we just want everybody to know that we have more information for work requirements. If anybody needs help with that, um we want to be able to help them kind of show them where they can go do the community hours, uh places they can go volunteer, et cetera. And um if they do have exceptions, they can do that. We can help with that as well. Like, for example, if somebody's injured and can't do these hours, we we want to be able to help help them through that process too. Yeah.

SPEAKER_02 9:22

So do we know when, like we just said, we don't know the date when work requirements will be in Dawson County. Do we think when that is active, would those patients be getting a letter knowing that that work requirements is starting?

SPEAKER_01 9:36

Yes, hopefully. Okay. Yep. And I think we were at a 15% and it has to be under eight. Okay. So that's the I guess the shift that we're waiting for to drop.

SPEAKER_02 9:47

Okay. So given the Tyson situation, you know, a lot of people are looking for jobs. There's only so many jobs given in in Lexington or, you know, surrounding areas. Talk to us about community members who maybe were on Medicaid or have moved outside of the county. Does that still apply to them? Or how, you know, what does that look like given those work requirements if you've moved?

SPEAKER_01 10:11

No, it won't apply to them. We actually just had a couple of patients in this scenario, one from Kearney and Eustace. Okay. And so when they were in those locations, the work requirements are now active.

SPEAKER_02 10:21

Because your your zip code is no longer Dawson County. Correct.

SPEAKER_01 10:25

Okay. Yep. And these requirements dropped in this year of May for the state of Nebraska.

SPEAKER_02 10:31

Okay. It's good to know and good to know that you guys are here to help walk people through this because it's new, right?

SPEAKER_00 10:38

This has never been to everybody, yes. It's due information. So we're learning as we go too, but we want to just be informed with other information that we can to be able to help them.

SPEAKER_02 10:49

Okay. So we've hit on this a little bit, but talk to us about the financial counseling, what both of you guys, I guess, can do to help patients in different scenarios.

unknown 11:00

Yeah.

SPEAKER_01 11:01

Um, I think a big uh thing that we help is patients with no insurance. It's easy as I can say. Patients with no insurance, that's who we help. Okay. Um, so then you break it down, you got Medicaid marketplace and Medicare. That's what we have found are the biggest avenues of insurance. And then if we can't find something through that, then we'll troubleshoot and help our patients that way. Um, but right now with Medicaid, we are really able to help them, like I said, get through that whole process. And then if they sign a DAR, then we will also receive that the mail that they get, all the verifications, all the notifications we also get. So we scan that and we put it into their profile. So when we update their case, we can make a call to them letting them know, hey, this is coming to a close. We need to show this, you need to um send in this verification. Um, and it is, it's truly helping them through the whole process because if this patient is going through a medical condition, who wants to be thinking about insurance? Who wants to be dealing with all of this paperwork? It's a complex system. They make it hard on purpose, right? Like this is not fun, it's not easy. So we're just helping to get through this. We're navigating, helping navigate a tough system.

SPEAKER_02 12:11

I love that. So if a patient is listening, hey, I don't have insurance, I'm gonna be losing insurance soon. What's kind of that first step that you would tell them to take?

SPEAKER_00 12:20

Um, to reach out to um the clinic, book an appointment with us. Um, if you don't necessarily know what to bring, bring what you have and we can go from there. At the end of the day, all we really want to do is just help.

SPEAKER_02 12:33

Talk to us about some of those documents that maybe a person, you know, if they're listening, should be looking for right now, or some things that are helpful when filling out a Medicaid application.

SPEAKER_00 12:42

That can include identification, social securities, your resident card, immigration status. If you are employed, we would need um proof of that, pay stubs. Um, and that's basically it. And taxes if you have those as well. But not necessarily needed.

SPEAKER_02 13:00

Okay. Vanessa, you mentioned a DAR form. Can you or Sandra just walk us through, you know, what does that look like? What are the steps to do it, and just maybe how helpful that is?

SPEAKER_01 13:11

Yep. So we have each patient that we help sign a DAR, which puts Lexington Regional Health Center, the organization, as their designated authorized representative. So then we are able to call in anytime and get any updates on their case. Okay. So then, as well with that, um, we get all the mail notification, like I was kind of saying earlier, and then we can do updates on their case and then reach out to them too. Um, and then we are now um, or if a patient has Medicaid and they would like us to be their representatives, we are going to start offering that upfront at FMS for patients too.

SPEAKER_02 13:50

So again, I mean, a choice if a patient wants to or not. But I mean, to me personally, I don't I don't see a negative aspect to it. I like we just talked about insurance is tricky. All the things that are coming in, I mean, is complicated. Why not have, I guess, an extra set of eyes able to help? Right.

SPEAKER_01 14:08

And the system is incorrect. Like, there's a lot of mistakes that happen, little mistakes. There, they're humans on the other side of this processing application. We're we're all gonna make mistakes. So we really are able to catch a lot of that because we do our research and we do um, we study this stuff. Okay. So we don't miss those mistakes.

SPEAKER_02 14:26

So just because you've been denied, it might it might not be fully accurate or might be worth taking a second look. Yes. Correct. Yeah. Okay. Well, ladies, thank you so much. What haven't we hit on, or what else do we just want to share with our community?

SPEAKER_00 14:39

We just encourage people to um reach out if they do need that assistance. Um, like we said, we're at the end of the day, we just want to be able to help everybody. I believe everybody should have insurance. Um, so we're here to help reach out to us.

SPEAKER_01 14:58

Yes, definitely. And like we just want it gets scary when we see um the situations where people aren't covered. I mean, they hurt our hearts. It's it's really tough to see those situations. And if we can help avoid that, then let's do it.

SPEAKER_02 15:13

We n I mean, most of the time we don't know when a medical condition is going to come. And so having coverage, especially for those what-if scenarios, I mean, it's I mean you're dealing with two things medical and financial. That's that's not fun. It's not fun for anyone.

unknown 15:28

Yeah.

SPEAKER_02 15:28

Oh, well, ladies, thank you so much for all you do. Thank you for being on the podcast today. Thanks for having me. I appreciate it. So, to our listeners, the biggest takeaway today is simple. If your income has changed, it might be work worth checking Medicaid eligibility again. If you were denied before, don't assume that maybe you aren't eligible today. Don't ignore those letters from DHHS. If you have any questions, we are here to help. And these amazing financial counseling ladies are here to guide you through the process. So thank you so much for listening to Vitals and Voices today. If you would please like, share, and subscribe to our podcast. Maybe send this to a friend who you know might be struggling with insurance. Um, and until next time, stay well.