Oleg I. Reznik, M.D.   Board Certified Family Physician

Assistant Professor at OHSU  Department of Family Medicine

Inconsistent Medicaid Coverage—a Death Due to Loss of Medicaid Coverage

I would like to report an example of what has become a rather common and unfortunate problem in our health care system. This patient of mine was a 43 year old man, who first came to see me in July of 2004. He described some psychotic symptoms and I started him on a regiment of an antipsychotic and an antidepressant. I had seen this patient nine times over a period of nine months. He reported a significant improvement in function as we titrated his antipsychotic up to a therapeutic level. Finally the patient reported that he found a job as a flagger and was doing well both at his job and in his relationship with his significant other. He reported that due to his new income he was being cut off from Medicaid. At that time I filled out a disability form indicating mental impairment. This was my last encounter with this patient in my very busy clinic, serving predominantly Medicaid population.

Three months later the patient’s mother and sister showed up for his appointment. They told me that the patient was indeed doing very well, better that they had seen him in many years, until he lost Medicaid coverage. They confirmed a longstanding prior diagnosis of paranoid schizophrenia. Now, without health insurance coverage the patient could not afford his newer atypical antipsychotics and his mental condition rapidly declined. He did not show up for the appointment due to paranoid fears of leaving the house. I gave them a prescription for an old and inexpensive anti-psychotic with instructions on titration and side-effects.

Several months later a medical assistant pointed out to me the patient’s name in the list of obituaries of the local newspaper. I contacted the family and heard a sad and gruesome story of extreme paranoia and attempts at self medicating that eventuated in the patient’s death. Paranoid fears had led the patient to taking methamphetamines, to stay up, which alternated with him taking large doses of methadone, all purchased illegally or given by “friends”, to calm down. It pains me to realize that had this patient’s Medicaid coverage not been terminated, this 43 year old man could have been a living and contributing member of society.