Fear of losing Medicaid benefits forces many disabled people to give up hope of working

Friday, Nov. 12, 1999 | 11:05 a.m.

Cricket Miller thought a college degree would get her started on the career that was sidetracked 21 years ago by a school bus accident.

The bachelor's degree in communications that she received from UNLV last spring seemed like the beginning of her goal to work in broadcasting.

But for Miller, a 37-year-old quadraplegic and a Medicaid recipient, taking a full-time job would mean having to choose between having and not having the nursing care she needs.

Should she make more than $1,500 a month, which includes income from government subsidies, Miller would lose her insurance protection under Medicaid.

The government program pays for a nurse to go to Miller's home each morning to help get her out of bed and get bathed and dressed. The nurse returns at night, spending nearly 25 hours a week at the home.

Paralyzed from the chest down, Miller is one of nearly 18,000 disabled Nevadans who rely on Medicaid. While the state does not keep statistics on how many disabled Medicaid recipients are able to launch careers, Miller is not alone in facing barriers that keep her skills out of the work force.

The government's fear, however, is that if working disabled persons were all covered by Medicaid, the cost of the program would exceed its capacity to pay. Which leaves Miller and others in her position frustrated.

For most non-institutionalized disabled people the income cap is $500 a month, 100 percent of the federal poverty level. Those on a Medicaid waiver program, such as Miller, can't earn more than $1,500 each month.

"I have the option to just sit here and do nothing but live off the system," says the gregarious Miller between checking in on a 10-year-old she occasionally looks after in the afternoons. "But I don't want to."

"A lot of what I'm dealing with is what most people with disabilities go through. You're almost penalized for getting a job."

If she were to pay out of her own pocket for the nursing service she needs, it would cost her between $1,500 and $2,000 a month.

Miller said she would like to pay a premium for Medicaid, as in private insurance. But Oregon and Massachusetts are the only two states in the country that have such an option.

Although it did not contemplate a plan including premiums, the Nevada Legislature this past session discussed changing income caps for disabled people receiving Medicaid. The idea was rejected after hearing a report from the Division of Health Care Financing and Policy that the cost would approach $140 million in its first year and $190 million in its second year.

"You really have to spend some money to get a program like this going," said Janice Wright, administrator of the health care financing division.

Wright told the Legislature that almost 50,000 disabled people would suddenly qualify for the program.

Sen. Ray Rawson, D-Las Vegas, vice-chairman of the Legislative Committee on Health Care, however, remains sympathetic to the idea, which he says will come up again at the 2001 session. "Nobody could provide the numbers to back that up," Rawson said of Wright's analysis. "It was an absurd cost." *

On Jan. 13, 1979, 16-year-old Crickett Miller, then a cheerleader from the small town of Hermiston, Ore., was traveling on a school bus with the wrestling team and other cheerleaders for an out-of-town wrestling match.

As the bus was wheeling down a highway at dusk, Miller, hoping to make her nap a little more comfortable, was propping up her knees on the seat before her.

That was the last time she propped up her knees on her own.

A semitrailer carrying four tons of apple juice lost its brakes and hit the bus. The trailer flipped on top of the bus, crushing the front end of the bus and the first three seats. Miller was in the third seat.

Her spinal chord was cut in two. She was paralyzed from the chest down, able to move her arms, but not her fingers.

"I was told right off the bat I couldn't walk," Miller said.

She spent the rest of that school year studying academic courses at night. During the days she learned all over again life's basic skills, such as feeding herself and brushing her hair and teeth.

Her wry sense of humor and free spirit mixed with strong family ties carried her through the change with little or no depression. That same attitude radiates from Miller today.

"Everything happens for a reason," she says with indifference in her dining room on a rainy afternoon. "If I was meant to spend my life in a wheelchair I was meant to spend my life in a wheelchair.

"In my mind I'm like everyone else except I don't have to buy shoes often because mine don't wear out."

Miller has never viewed the accident as a deterrent to living a full life.

After the accident she returned to school the following year. No longer a cheerleader, she participated in sports by keeping stats for the basketball and wrestling team.

She became a self-appointed liaison between the handicapped and inquisitive children by speaking to students at elementary schools. She answered questions many children and adults alike wonder about but are afraid to ask.

"How else are they gonna know," she says with a light smile. "Most people will stare at paralyzed people because they're so curious." Even the parents showed up to hear her talk, she added.

Miller graduated with her class and moved on to purchase and operate a video arcade with her brother, serve as a volunteer for various organizations and become a glamour model.

After moving to Las Vegas with her family she became a volunteer for the CASA Foundation, representing abused and neglected children in court. She received the volunteer of the year award for her efforts in 1993.

She ended up in college because she wanted to be a sports announcer.

After taking a few classes at the Community College of Southern Nevada she moved on to UNLV. In addition to her communications major, she minored in theater. During her senior year at UNLV she worked as an intern at the local Public Broadcasting Station, Channel 10. For the past six years she has been working part time as an usher at the Thomas & Mack Center.

Her physical limitations only keep her from getting out of bed in the morning, not from achieving her goals, she said.

And now that she's out of college she wants to join the working world on a full-time basis.

She would like to be a broadcaster and even thinks about possibly being a talk-show host someday. "Actually, I wouldn't even need guests," she adds jokingly. "I could just talk and talk and talk."

Karren Rhodes, spokeswoman for the state Department of Employment and Training and Rehabilitation, said many disabled people work out arrangements with their families so they don't have to rely on Medicaid. Some work part time or volunteer in the community.

Miller, however, says she doesn't want to rely on family or friends to get her out of bed every day. "I want to function like anyone else," she said. "Once I make the money I don't mind paying."

And once her career took off, she says she could afford to leave Medicaid behind.

"The place that I give up will go to the next person." *

Paul Gowins, who works for the state of Nevada's Office for Community-Based Services, is familiar with Miller's frustrations.

As an advocate for the disabled and a quadroplegic himself, he has been through the same process and worked around the same barricades. The decision to leave Medicaid is a risky one for disabled persons, Gowins said. "It's the No. 1 reason why (disabled) people don't go to work."

Gowins says he pays about $12,000 to $13,000 a year in medical expenses.

"To earn enough to pay for that out of your pocket you have to make about $50,000 a year," Gowins said. "Coming out with a bachelor's is probably not going to do that. A lot of us went to school for some time."

Private insurance doesn't cover the type of service that Miller and other disabled people need, Gowins said.

"I would not do what I did again," Gowins added. "It's an extremely big risk and in good conscience I could not advise someone to go to work in a maybe deal. You have to be very careful about losing your medical benefits."

Those who need to return to Medicaid are up for another difficult transition, he added, citing some of the qualifications for Medicaid. Medicaid recipients are not allowed to have more than $2,000 in savings.

"If you saved money you have to get rid of money."

A home can be kept if it is a primary residence and the owner can afford it. A vehicle can be owned if it's not worth more than $4,500.

Some need to return to subsidized housing, which isn't always available, Gowins said.

"Some took the risk and it turned out OK. Others it didn't and they wound up defeated.

"It's really a trap. You don't really realize it until you get to the end." *

Meanwhile, Miller keeps hoping that the system will change for people in her circumstances. She says paying premiums to Medicaid in exchange for keeping its benefits would enable her to achieve her dream.

"If I was paying so much a month I could continue to have in-home nursing," she said.

"I'd like to be just like everyone else: Get up, go to work, come home, save money," Miller said.

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