A Fight to Restore Coverage: Bob’s Story

Meet Bob 

As someone with a lifelong disability living on a fixed income, Bob’s Medicare and Medicaid coverage allowed him to get weekly dialysis, see a heart specialist, and afford the medications he needed to be and stay healthy. For Bob and millions like him, dual coverage is a lifeline.

“I have kidney failure,” said Bob. “They’ve told me without dialysis, I have like a 30-day span, or else there’s a good chance I’d be dead.”

That stability disappeared when Bob and his caregiver, Claudia, moved from Massachusetts to Pennsylvania. 

Because Medicaid eligibility is state-specific, Bob was required to reapply after the move. Under Pennsylvania’s rules, there was a strict $2,500 asset limit. Because two months of Social Security checks briefly put his account just over that threshold, Bob was deemed ineligible. His application was denied. 

That Bob and Claudia assumed would be a seamless transition between two public insurance programs instead became an almost year-long ordeal — highlighting what happens when Medicare and Medicaid operate as disconnected systems rather than a coordinated whole. During that gap, Bob was left uninsured at the very moment he needed care most. 

Even after Bob’s account balance dropped below Pennsylvania’s limit and he appealed with all required documentation, rigid bureaucracy, duplicative verification processes, and system delays prevented timely coverage. Despite meeting eligibility criteria, Bob remained underinsured. 

Shortly after the move, doctors discovered Bob had an undiagnosed blocked heart. He was rushed into emergency surgery and received a pacemaker. The doctors saved his life — but without coordinated Medicare and Medicaid coverage, Bob was left with crushing medical debt. 

This is what happens when systems fail to work together. Better integration between Medicare and Medicaid could have prevented months of delays, ensured continuity of coverage, and protected Bob from medical debt during a medical crisis. 

Desperate for help, Bob hired a lawyer to navigate the same paperwork he and Claudia had already submitted on their own. After nearly a year and a half without full coverage, he was finally approved.

More than 12 million people are dually eligible for Medicare and Medicaid. Many are older adults and people with disabilities who live on low, fixed incomes and manage complex or chronic conditions such as kidney failure or heart disease. They often rely on both programs to cover hospital care, medications, long-term services, and daily supports. 

Bob’s story underscores what’s at stake when Medicare and Medicaid are treated as separate systems instead of coordinated supports. Despite having lifelong disabilities, complex medical needs, and clear eligibility, Bob fell through the cracks — at enormous personal cost. 

People shouldn’t have to hire a lawyer or endure months of coverage gaps just to survive. Dually eligible people deserve a health care system that works together across programs, responds to life changes, and delivers seamless, person-centered care. 

What Needs to Change 

In the wake of H.R. 1, states face new administrative pressures and more red tape. While dually eligible people are technically excluded from some harmful provisions, strained systems, reduced resources, and poor coordination between Medicare and Medicaid increase the risk of errors and delays — leaving people like Bob without essential care. 

Congress can protect dually eligible people and promote better integration between Medicare and Medicaid by taking the following steps: 

• Making Coverage Easy to Keep — Require states to align renewal rules and timelines across Medicaid eligibility pathways, streamline paperwork, and provide at least a six-month grace period when coverage is lost due to technical issues, system errors, or administrative delays. Congress should also repeal the ten-year moratorium on Medicaid and Medicare eligibility rules that would have helped simplify enrollment and renewal for people who are dually eligible. 
• Ensure Automatic Exemption Status — States should use Medicare enrollment data to automatically exempt dually eligible people from work requirements, prevent wrongful terminations, track impacts on this population, and establish clear outreach and resolution plans for beneficiaries and caregivers.
• Give Dually Eligible People a Seat at the Table — Create a national advisory council of dually eligible people, caregivers, and advocates to guide federal policy and ensure programs reflect lived experience. 
• Invest in Ombudsman Programs — Require every state to fund an independent ombudsman with authority to resolve Medicare–Medicaid coverage and care disputes — regardless of where someone lives. 
• Create Streamlined Transition Policies — Establish policies that require states to expedite reassessments, simplify verification, and maintain coverage continuity when people move between states — preventing gaps caused by disconnected systems.

For millions of people, Medicare and Medicaid coverage is the difference between life and death. Bob’s experience shows why better integration between these programs is critical — so no one is left navigating two disconnected systems during a medical crisis. 

Call to Action

If you or someone you love relies on Medicare and Medicaid, your voice can help push for policies that make coverage easier to keep and promote integration between programs — so no one falls through the cracks. 

Record a short video sharing how these changes could affect your life—whether you’re a caregiver, an older adult, or someone living with a disability. Your story can help policymakers understand what’s really at stake.