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Wet eyes and long stares fill the wordless spaces.
Sitting across a spare table, the 50-something couple who have been together for 17 years – married for almost 11 – recount the unfortunate set of circumstances that led them to divorce. The legal split was finalized in April, and they live in separate homes, but Patty says their covenant before God is still intact.
They just wish they were still married.
“It’s just surreal,” Tom says.
“You think, ‘How could this possibly be?’ ” Patty says.
Their troubles began when Patty noticed a lump in Tom’s chest in October. She felt the mass near his right nipple, thinking at first that it might be an ingrown hair or cyst. When the nipple inverted about a month later, she pressed Tom to get it checked out. Tom dragged his feet, later blaming anxiety and lack of awareness about a disease that usually afflicts women. After the couple went out to dinner one night, Patty took Tom on a surprise visit to a RediMed urgent care clinic. A doctor there told him he needed to see a surgeon immediately.
A biopsy later revealed Tom had breast cancer. A curved scar sweeping from near his sternum under his right arm marks the Dec. 31 operation to remove a Stage 3 tumor and 11 lymph nodes around the affected area, including one lymph node with cancer cells in it. He’d have to endure chemotherapy and other treatment as well.
All the while, the couple were fighting another battle, desperately seeking coverage to pay for Tom’s treatment. Since losing a job in library services at a university in the region four years ago, Tom had been uninsured. A modest retail job had promised coverage in January, but it was too little too late. The benefit wouldn’t cover a pre-existing condition.
Tom hadn’t signed up for COBRA health coverage through his previous employer because of its hefty price tag: about $900 per month, about what it would have cost Patty to add him to her policy. Now, because he’d been without coverage, he couldn’t get insurance to cover cancer treatments even if the couple were able to pay for it.
And the bills were mounting.
At the end of their rope, they sought Medicaid coverage – an unlikely prospect given that the couple’s combined income at the time was about $50,000. They didn’t qualify. They checked out the new Healthy Indiana Plan, but again they weren’t income eligible. Finally, after consulting an attorney and a friend, they decided to do something sure to exacerbate an already emotionally wrenching experience.
The couple filed for divorce in February.
“We absolutely, absolutely believe we exhausted all the alternatives,” Patty says. They needed to lean on each other more than ever, but their insurance coverage solution required them to be apart.
Working part time around cancer treatments, Tom now takes home about $65 per week after taxes, just enough to make car payments, buy gasoline and cover co-payments on medications amounting to $12 a month. As an unmarried person, he is eligible for a Medicaid program that covers his breast cancer treatment. But to qualify, he first had to spend down all but $1,500 of a modest life insurance policy worth $4,000 so that he could meet asset requirements.
That, too, is a sore point for the couple, who question why someone facing a life-threatening condition would have to get rid of assets that could be useful for his next of kin if the worst happened.
“Now (that) he has cancer, he can’t get life insurance,” Patty says.
At times during two sit-down interviews, the couple appeared despondent, but a pervasive fighting spirit shone through as well. Their resilience to beat cancer dovetails with a disdain for the woe-is-me attitude.
They have had to battle a killer without the benefit of sharing the same home, of being married. Tom boards with a family friend about two miles from the couple’s home. In exchange for free room and mostly free board, he runs errands, pitching in with housework, providing some transportation and giving an extra sense of security for the woman who is in her 70s.
The couple are thankful for the arrangement, and they spend as much time together as they can, Patty says. But they’d still much prefer what they had before the insurance fiasco.
Thinking about the divorce, “We’re either outraged or incredibly sad,” Patty says.
“Obviously there’s some things that need to be fixed” with the system, Tom says.
Patty estimates Tom’s cancer bills exceed $80,000, and that’s for care provided at a discount by medical professionals the couple say have been extremely helpful throughout the ordeal. Still, almost half their bills aren’t covered by Medicaid. That’s because Tom’s modest life insurance plan precluded him from qualifying for the 90-day retroactive coverage that would have addressed nearly $40,000 in medical bills before May 1 when his Medicaid benefits became effective.
Patty, who earns about $38,000 a year, makes an occasional payment on the debt they incurred before Tom qualified for Medicaid. But supporting two grown children at home and helping a third who recently got laid off from a job has kept her from making any inroads. She describes her children (all from Patty’s previous marriage) as hard-working and the situation as temporary – the result of everything from low-paying jobs and medical expenses to life transitions. She plans to eventually move out of the four-bedroom home and into an apartment to reduce her expenses.
Still, even after all the couple went through – getting divorced to get Medicaid coverage – there’s a strong probability that Tom will have to file for bankruptcy because of unwieldy medical bills.
Experts say so-called strategic divorces aimed at gaining access to Medicaid coverage for a person are rare. Even so, Patty and Tom aren’t alone in their situation, and the still small number of strategic divorces might be growing according to some anecdotal evidence.
“I have consistently done one a year,” said V. Anthony Vilutis, a Fort Wayne-based elder law attorney who concentrates in Medicaid and Medicaid planning. “Now I’m running two or three a year.”
Most of his cases involve couples who want to get Medicaid for a spouse to defray the cost of putting that person in a nursing home, which usually runs about $5,000 a month on average, he said. That’s up from about $1,200 when Vilutis started practicing 30 years ago. The rise in nursing home care costs is, he believes, the No. 1 reason for the uptick in strategic divorce cases.
Changes in state law that allow Medicaid to recover costs after death from a recipient’s spouse’s estate (in addition to the recipient’s estate) and an increasing number of second marriages where couples seem more open to divorce, appear to have contributed to the increased number of cases as well, Vilutis said. Patty and Tom were each other’s second marriage – Tom having lost his first wife to cancer, and Patty a divorcee.
In general, Vilutis says Medicaid’s income eligibility threshold makes it difficult for many married couples to qualify for the program, while ever-increasing medical costs put even well-heeled couples in a tight spot.
“The income threshold is really low,” he said, pointing out a married couple must live on $956 per month after medical bills to qualify.
Dr. Jeff Wells, director of Indiana Medicaid, conceded that the state program has tended to have a low income threshold but an extensive benefit package relative to other states.
He couldn’t speak to the specifics of Patty and Tom’s case because the couple had chosen to remain anonymous. But he said such instances are “pretty rare,” adding that the state is expanding health benefit programs to cover more people.
“I think it’s an unfortunate circumstance when people feel they need to divorce to obtain health coverage,” Wells said.
Medicaid eligibility requirements and other program parameters are set by state and federal law. Program officials say they work hard within those parameters to make sure those qualified for governmental insurance get coverage. They invited the couple to contact them to revisit their case.
Just as Patty and Tom got divorced for insurance reasons, others are getting hitched to get covered.
According to a poll commissioned by Kaiser Family Foundation released in April, 7 percent of adults say that, in the past year, they or someone in their household decided to get married to have access to their spouse’s health care benefits or so their spouse could have access to their benefits.
While coverage issues fester, Tom’s battle with cancer continues.
Although chemotherapy and other treatments have gone relatively well, he still bears the same challenges of many other cancer patients: not knowing if or when he will be out of the woods. Particularly, because his cancer was diagnosed in a later stage, the couple fear the disease’s spread and lament not having a more concrete yardstick to measure treatment progress.
Tom’s energy dips sometimes and his short-term memory has suffered in the wake of intensive treatment. But he’s happy to be able to work some and has no plans to apply for disability. He’s scheduled to finish chemo treatments this week. He’ll go to a doctor July 15 to see if he needs radiation.
His goal is to be able to dance with his daughter at her wedding in September.
mschroeder@jg.net
