Ashley McMillian, 31, right, with her son Travion Parker-McMillian, 12, and her daughter Tatiyana Parker-McMillian, 11 months old, at their home in north Lakeland. McMillian’s husband, Albert McMillian, is a long-distance truck driver and was not available for the photograph. Michael Wilson / The Ledger


LAKELAND – While temporarily homeless during her first pregnancy, Ashley McMillian struggled to get on Medicaid, a federal-state health program people assume is always there for pregnant women and kids.It took someone at the Florida Department of Health to get the right forms filled in for her to start getting Medicaid-covered prenatal care in her fourth or fifth month.

That was 12 years ago.

Since then, she and her husband have gone through being unemployed, working full time, being on and off Medicaid for health care, as well as on and off Medicaid “share of cost.”

That program, also called the Medically Needy program, is for people whose income or assets are higher than Medicaid limits but who are struggling financially. In it, people’s allowable medical expenses must reach a certain level before bills start being covered.

Each month, certain medical expenses they owe or have paid in the last three months are counted toward their share of cost. When allowable medical expenses equal their share of cost, they are eligible for Medicaid for the rest of that month.

It’s similar to an insurance deductible, state officials say, although some on the program say it’s confusing. McMillian said it felt like having no insurance at all.

“It should be easier for lower-income, working-class people to receive Medicaid,” said McMillian, 31. “A lot of jobs offer insurance, but it’s usually not affordable for people living paycheck to paycheck.”

Increased income from a full-time job can knock out Medicaid eligibility — even if someone is not financially secure enough to afford private insurance, a common occurrence among people who seek care at one of Polk County’s free or reduced-cost medical clinics.

The number of people on Medicaid or Medically Needy/Share of Cost in Polk fluctuates.

In March, Polk had 47,332 people on Medicaid and another 48,305 on share of cost. Numbers were slightly lower for June, with 46,753 on Medicaid and 47,749 on share of cost.

Eligibility guidelines would have become broader if Medicaid expanded under the Affordable Care Act. Such expansion would have made 669,000 more people eligible in Florida, about 29,000 of whom would have been in Polk, according to the Kaiser Family Foundation. The White House Council of Economic Advisers gives a higher Florida estimate, saying 750,000 would have insurance coverage next year if the state expands Medicaid.

But Florida and 20 other states so far have rejected that option.

When McMillian worked full time at a drugstore chain for $6.20 an hour, she said, insurance for herself, her husband and one child would have cost more than $200 every two weeks. Her husband, Al, was working as a cook at a diner.

They couldn’t afford it.

A message she’d like to get across to policy setters:

“It’s hard when you’re working to keep the Medicaid. I can barely afford my bills, but you won’t help me with insurance to keep up my health.”

Sixty-four percent of Floridians who could have qualified for expanded Medicaid are in working families, Kaiser said, and 79 percent are adults without dependent children.

Having young children makes it easier for the McMillians to get Medicaid, at least when their income is within the current guidelines. Affordable private insurance remains elusive.

A second child, born one year ago and still being breast fed, led to issues at Ashley McMillian’s drugstore job, propelling her in February to take a job as a breast feeding peer counselor at the Women, Infants and Children program.

She loves what she’s doing at the Health Department, McMillian said. But because her job is contract work, it doesn’t come with insurance. Al McMillian has a new job as a long-distance truck driver, also without insurance.

She and her husband are back on Medicaid share of cost, she said, but Travion, 12, and Tatiyana, 1, still qualify for Medicaid coverage.

Finding doctors willing to take Medicaid hasn’t been difficult in seeking pediatric or pregnancy-related care, she said, mentioning Exodus, JayCare, Doctor Today’s urgent care clinic and Lakeside Pediatrics as places they used.

Specialty treatment for her polycystic ovarian syndrome was another matter.

“It was hard trying to find care for that,” she said. “I would end up in the emergency room in excruciating pain.”

That led her to Exodus, which is why she stayed there for her second child instead of returning to the Health Department’s prenatal care.

The Health Department’s WIC program has been a major relief in getting food for their family of four.

Family income can be up to 185 percent of federal poverty guidelines for women who recently were pregnant, infants and children younger than 5 who are at nutritional risk. For a family of four, that would be up to $863 a week or $3,739 a month.

In Polk and Hardee counties combined, 21,448 individuals are on WIC, said Suzanne Wright, the program’s nutrition director in those two counties.

“It’s been a good program,” McMillian said. “Milk’s expensive. Cheese is expensive. Eggs are expensive.”

WIC covers specific foods, not just anything a family wants.

“They can’t get just any cereal,” Wright said as an example. “They can only get cereals low in salt and sugar.”

A change effective July 1 did allow whole wheat pasta, tortillas and yogurt, which Wright said WIC clients will appreciate.