Achieving wellness through Medicaid expansion

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In order for most people to be healthy, they have to be able to access health care. And for more than 41,000 Alaskans, that problem was solved through Medicaid expansion. Andi Riley is one of them.

“We want this to feel like a second home to individuals,” Andi says as she walks around the comfortable, couch-filled room at her workplace. “Especially to people who don’t have a home.”

Andi works at the Alaska Mental Health Consumer Web, a drop-in center for people with mental illnesses that offers kitchen space and access to computers. She used to be a consumer herself when she was homeless. Now she’s an employee, touting business clothes and elegantly styled curls. But for a reality check, she points to her employee badge photo.

“That’s what this picture is about, with my flyaway hair. That’s my human side.” She says she doesn’t always look so put together.

A few years ago, when Andi first started working at the Web, she was struggling. Not with her mental health — with her physical health.

“There was a lot of things going on with my health,” she says. “I missed quite a few days of work, or was severely late and not able to very well manage my symptoms.”

[Related: What it takes to respond to a mental health crisis]

But she couldn’t afford to see a doctor, and she couldn’t get on Medicaid – she earned too much from her job. She fell into the gap. She ended up going to emergency rooms, even for minor things. Eventually, she realized that she couldn’t keep putting off dealing with how terrible she felt most of the time. She was finally admitted to a sliding-scale clinic and learned that she had type two diabetes. But a diagnosis didn’t help much.

“I couldn’t get treated,” she says. “I wouldn’t be able to afford the prescriptions. I couldn’t afford the ongoing care, like blood draws and doctors appointments.”

Then she got on Medicaid. Now she works consistently and can spend money on food and housing instead of medical bills.

Katie Baldwin-Johnson is with the Alaska Mental Health Trust, which is helping spearhead Medicaid reform and pay for some costs of expansion. She says Andi’s story is pretty typical. Low-income earners can’t afford to look after themselves, so they aren’t as healthy.

“They’re not taking care of themselves,” she says. “So having access to a primary care provider, for example, where maybe someone did not previously, certainly could help with stabilization in a work placement.”

Medicaid expansion started in Alaska in 2015 to provide health care to low-income adults who don’t have dependent children. The fight over it went all the way to the state Supreme Court. It was so controversial because Medicaid is one of the most expensive items in the state budget. But, for Medicaid expansion, the federal government pays more than 90 percent of the cost.

Katie says Medicaid expansion has been especially important for people with mental health issues. Access to medical providers helps catch illnesses before they get really serious and cost more to treat or cause other problems. People with substance use disorders can get treatment through Medicaid, which reduces the cost burden on society.

[Related: Alaska’s Medicaid and public assistance backlog is 20K people deep]

Citing a recent study from the McDowell Group, Katie says, “When people are using alcohol and drugs, and impacted by addiction, there’s a huge cost. Billions of dollars to our state in loss, workforce productivity, accidents, health care consumption, you name it.”

The Department of Health and Social Services is working on ways to measure the cost-effectiveness of Medicaid expansion and reform. Katie says to figure out societal savings, you’d have to look to how many people kept their housing because they were mentally stable or stayed out of jail because they received addiction treatment.

Or kept a job- like Andi.

Andi’s healthier now. Her blood sugar is in check. She’s not on insulin anymore. She still struggles with some bills and helping her husband, who has a disability. But now, she can also have time for important things, like connecting with family through a love of sports. The Minnesota Vikings logo pops from her screensaver. She says she’s a big fan.

“My family’s from Minnesota, and it’s my way to connect with my family long distance,” she explains.

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