Her wait is over. NC cancer patient now eligible for Medicaid to get life-saving care

DeAnna Brandon, who has a rare blood cancer and has struggled to get necessary health care due to not having insurance, gained access to Medicaid this October after more than a yearlong delay and multiple denials of coverage. She can now take the next steps to get life-saving care.

For the 45-year-old Rowan County resident, getting coverage means she can “breathe again,” she said.

It also means the chance to extend her life and live “with more hope and and feel like you can make goals to try to reach, because before it was like, ‘what’s the point of making goals if I’m not going to be here that long?’” she said.

Brandon was diagnosed with multiple myeloma, which has no cure, in 2022. Since her diagnosis, her doctors have recommended she get her own stem cells drawn as soon as possible to use for a transplant. This, doctors said, will help extend her life by up to 20 years. Otherwise, she could have as little as three years left, as previously reported by The News & Observer.

However, Brandon was unable to get stem cells drawn at the time as she was ineligible for Medicaid, a state-federal insurance program that would cover her transplant.

North Carolina, until just recently, was one of just 11 states that had not expanded Medicaid, which meant that the income limit for eligibility under the program for a parent or caretaker in North Carolina was 41% of the federal poverty level, or just over $8,000 yearly for a family of three.

Adults without children, save for those with disabilities or other qualifying exceptions, had no coverage. This left out Brandon, a single mother who lost her Medicaid coverage in 2016 after both her kids turned 18.

In March, lawmakers and Democratic Gov. Roy Cooper approved a bill to expand Medicaid, as allowed by the federal government, to cover all adults up to 138% of the federal poverty line, with 90% of costs paid by the federal government for the expansion population. This means all adults who make below about $20,120 a year can get access to health insurance.

But the enactment of Medicaid was tied by lawmakers to the passage of the state’s two-year budget, which should’ve passed by the end of June, but was delayed until October due to internal GOP fights , largely on whether casinos should be legalized.

“I feel like I’m holding my breath to get a decision as to whether my life can be extended or not,” Brandon told The N&O back in September.

Disability claims

Considering the uncertainty at the time on the timeline for expansion, Brandon attempted other ways to get coverage , including filing for Medicaid coverage for people with disabilities, considering her cancer symptoms, which include fatigue, memory loss and more, she said.

She first filed for Medicaid for people with disabilities in 2022, shortly after her diagnosis. However, this was denied due to not meeting federal Social Security disability requirements. So she tried to get coverage by filing for Social Security disability benefits, which would have made her automatically eligible for Medicaid. She is still waiting to hear back on this, despite hiring a lawyer and sending over hospital records, she said.

Then, she tried filing for Medicaid for people with disabilities once more in March. This was denied once more. She appealed the March decision with the state, and had a phone call on Sept. 26 with a hearing officer with the state’s health and human services department to explain her case.

Meanwhile, charity care, through which hospitals provide free or discounted services to eligible low-income patients, would also not cover the cost of up to $200,000 to harvest and transplant her own stem cells, she said.

While undergoing treatment and diving through bureaucratic red tape, she also advocated, speaking with multiple news outlets, for the expansion of Medicaid.

Celebrating Medicaid coverage

So when news on the enactment of expansion being set for Dec. 1 came out, it seemed it would be Brandon’s ticket to getting coverage for her stem cell transplant.

But, in early October she was at her boyfriend’s home in Rockwell when she received via mail a decision on the appeal she had filed with the state in late September, regarding the determination of ineligibility for Medicaid disability.

Brandon did not open the mail immediately, fearing bad news again, and instead waited for her boyfriend to get home and read it first.

“When he said ‘oh, OK, ‘you won your case,’ I was like, ‘no way,’ and I grabbed the paper from him and I’m looking at it — I’m like, dancing around,” she said.

Documents shared by Brandon show the decision granting her Medicaid coverage under a disability determination was made on Oct. 2, less than a week after the phone call with the hearing officer.

Brandon said the positive determination meant she could finally begin the steps to get the stem cell transplant, including getting any necessary tests prior to surgery. She also can get a needed neck surgery — pending Medicaid approval, which requires getting authorizations — hopefully this month, she said.

The determination was also retroactive to December 2022, meaning many of the medical bills she has in a three-inch stack in a briefcase may be covered.

It’s a long road, with an over a yearlong recovery process, between the two medical procedures.

“I’m nervous and excited and I’m just hoping that my body can handle it well,” Brandon said, “But, in a sense, it’s now or never.”