The Interview

What happens when you don’t fit in the system

The form letter arrived in a plain white envelope one morning casting an accusation of suspicion.

Dear Taxpayer:

	Our records indicate that you may have income or other resources that were not considered when determining your eligibility for your health insurance subsidy.  Your benefits may be affected by our determination.  
        
        An appointment has been set for you to come in and discuss your financial situation with your caseworker.

Today was the day of the appointment that was set for her without her consultation. She finished her coffee, rinsed the cup, and placed it on the drainboard alongside the kitchen sink. She took one last look at herself in the hallway mirror by the front door of her home and pulled back her grayish hair into a neat ponytail, sighed, then walked outside onto the city sidewalk toward her destination: The State Income Support Division - downtown office.

Her home was a historic house in a neighborhood just blocks away from the downtown high-rise buildings of a mid-sized city. She greeted her neighbors as she walked by, and they returned her smiles with friendly waves and requests to stop by on her way back home from her walk.

The waiting room of the State Income Support Division felt judgmental. Upon her arrival, she was politely asked by a uniformed security guard to “sign-in” on a form clenched to a clipboard. She wrote: Roma Frewinn 10:24am in the appropriate columns of the form. The guard told her to empty her pockets so he could scan her with a hand-held metal detector. Roma didn’t have any pockets in her unadorned, single-piece woolen dress, but she did carry a small purse which she placed into the basket on the guard’s desk. The scan was negative. He asked to search her purse. She consented. Again, the guard found nothing of interest. Satisfied, he allowed her to pass and instructed her by rote to stand in line at the check-in window. Roma did as she was told.

The check-in line snaked out from the last window along a bank of five windows on the far wall. Only windows two and four were occupied by clerks speaking with people seated before them. The remaining windows were shuttered with metal roll-up doors behind the glass. The faces of the two clerks behind the windows transmitted identical expressions of tired disbelief which was betrayed by the frowns on their lips and their ever so slightly raised eyebrows. Roma turned her attention to the several people seated in the rows of hard-backed chairs waiting for their turn at the windows. They all were actively trying to mask their defeated postures with polite appeasement when they weren’t successful at avoiding eye contact. No one in the room wanted to be there.

It’s embarrassing to ask for help. It also feels unethical to deny help to people who honestly need it. She looked at the people waiting, then at the people behind the windows and wondered, “Who here has a harder time sleeping at night?” Her thought was interrupted when a middle-aged clerk began moving along the growing check-in line asking people the reason for their visit. The clerk told most of them to continue waiting but another was directed to get out of line to finish the paperwork he held in his hands. When the clerk got to Roma, she showed the letter she received in the mail.

“Meet me at window three,” the clerk said as he turned away from the remaining people waiting behind Roma. The clerk disappeared behind a locked door in the far wall and reappeared behind window three after rolling up the metal security barrier. Roma met the clerk at window three.

“Let me see your letter again, please,” the clerk said. Roma handed the clerk the letter. The clerk keyed some information into a computer, clicked the computer mouse several times, then handed back the letter.

“Have a seat, and someone will meet you from the side door,” said the clerk.

“Thank you,” Roma said, then rose to take a seat with the other visitors. She tried to locate which side door the clerk had indicated but found none.

A minute passed and she heard her name.

“Roma?” said a man’s voice from around a corner of the wall to her right. She stood up and walked toward the hidden voice. Around the corner of the wall stood a young man in his late thirties. He wore dark suit pants, a blue dress shirt, a solid blue tie and stood in a doorway holding back the heavy wooden office door with his body.

“Follow me, Mrs. Frewinn,” he said.

“Ms.,” she replied.

“Oh, ok. I’m Charles,” he said, as he held the door back for Roma to enter an interior part of the office which was off limits to those waiting at the windows.

They walked down a corridor lit only by the cold fluorescent lights overhead until they came to the open door of an empty office.

“Have a seat,” said Charles.

She sat in an armless, un-upholstered, molded plastic seat facing a desk. He sat behind the desk and immediately looked into his computer monitor which stood as a barrier between them.

“Now, Ms. Frewinn…”

“You can call me Roma,” she interrupted.

“Roma. Thank you. Now Roma, it looks like you’ve been on Medicaid for over six years. Is that right?”

“Yes.”

“I admit that our system is a bit backlogged, but it doesn’t appear that we show any income tax returns to verify your income,” he said, still looking at his screen. Then, he turned and looked directly at her. “Do you have any income?”

“Yes,” she replied. He waited for more, but there was no more.

“Ah… well, did you file a tax return last year?” he asked.

“No.”

“But you had income,” he stated.

“Yes.”

“How much income?”

“I don’t know,” she shrugged. “A little.”

“How did you earn it?” he asked.

Roma thought for a moment. She thought about Cassidy, the young woman to whom she rented an apartment. The apartment was the back half of Roma’s house which was divided many years ago into two living spaces - like a mother-in-law suite. Cassidy was mother to 4-year-old Jacob who was now in a half-day preschool which was adding to Cassidy’s financial burden. But at least Cassidy could take on more hours at work. Still, Roma was lenient on how much she charged Cassidy. Cassidy had been her tenant while still pregnant with Jacob and in that time had become like a daughter to Roma.

“I have some rental income,” Roma said to Charles. “But it’s less than the minimum threshold for filing a tax return.”

“How much do you make?” he asked.

“Oh, about nine thousand.”

“Do you have documentation of the rent payments?” he continued.

“No, I’m usually paid in cash.”

“Right. I see. And all of your needs are covered with just nine thousand dollars?” Charles asked skeptically.

“Oh no. That’s far too inadequate.” she said matter-of-factly.

“So, you have other income then?” he asked.

“Nope. No other income.”

Charles looked down at his desk, sighed, then looked back up at Roma.

“Ms. Frewinn…Roma. You are at risk of losing your Medicaid benefits if I can’t come to some understanding of your financial situation. Do you understand?”

“No, I don’t understand,” she said honestly. “What have I done wrong to make you want to deny me access to medical care?”

“You haven’t done anything wrong. It’s just that the system requires updates to financial information, and we haven’t had any additional information since you enrolled for financial support….,” he glanced at his computer, “…six years ago.”

“The system requires this?” she asked flatly.

“Well… yes. It’s an automated process. If there is no update after a certain time, the computer flags your account for an audit.”

“Charles. We are two people who wish to solve this problem with your system. Right?” she said.

“Yes, I’m here to help you,” he replied.

“Then what do you need to do to satisfy your computer’s demand for an audit?”

Charles thought for a moment, then leaned forward toward Roma earnestly.

“How is it that you are surviving, that you are making ends meet, Roma? Help me understand that,” he said curiously.

“My community enables me to survive. That’s how.”

“What does that mean? Like Medicaid?” he asked.

“That’s part of it, but it’s much bigger than that,” she said.

Charles looked back at his screen and scrolled farther down. “I see that you are only on Medicaid. You don’t have any SNAP benefits or other forms of income assistance. In fact, you’ve only used your medical benefit twice over the past six years. What other supports are you using?” he asked.

Roma thought about her home and property. Her home was one of the first to be built on her street back when much of the land was still a pecan orchard. Her lot remained one of the few generously sized plots of ground at about one-third of an acre. This allowed her to grow a large garden of vegetables and herbs among several fruit trees that produced apples, peaches, cherries, and figs. These were in addition to the huge pecan tree which was a remnant of the original orchard.

“I grow a lot of my own food,” she said proudly.

“Can you live only on what you grow?” he asked with some confusion.

“Oh, no. That would be impossible. Much of it would spoil before I could eat it all on my own - even with all the canning and pickling I do.”

“So, what do you do with your extra food?”

“I give it away!” she declared.

“To homeless people?”

“No, to my community. My neighbors and friends, Silly,” she said with a teasing smile.

“You give away your extra food to your neighbors and friends. That’s very generous of you. So how do you get the extra food that you need?”

“My community gives it to me.”

“Like a barter network,” he said, catching on. “You give someone apples, and they give you eggs.”

“Oh, no. Not for eggs,” she said abruptly, then gave it some thought.

She thought about her eight chicken hens which regularly provided nearly three dozen fresh eggs a week; more than she could eat all by herself. She shared some with Cassidy in exchange for her help in caring for the chickens. Jacob loved playing with the hens, entertaining him and “the girls” for hours. In addition she had two ducks and one goose all of which produced an ample supply of eggs to eat and trade. Then she continued speaking, “I actually give eggs away, too.”

“It sounds like you have a mini farm there in your backyard,” he said in a slightly mocking tone.

“You could say that. It keeps me busy enough,” she said.

“Too busy to get a job, I guess.”

“Why would I need another job when I’m busy enough,” she said with some confusion.

“If you had a proper job, you wouldn’t require Medicaid,” he said sharply.

“What’s a proper job?”

“One that gives you benefits,” he explained.

“My job gives me better benefits than just medical and dental care,” she said dryly.

“You’ve rarely used your Medicaid benefits, true. So, where do you get your medical care?” he asked.

Roma looked away and thought of Dr. Roscoe, a woman who lived around the block from her house, and also valued community and personal support. Dr. Roscoe provided annual physicals for Roma plus as needed consultations and referrals in exchange for the many items that Roma’s home provided, especially canned peaches, fresh tomatoes, and homemade fig newtons.

“My community network,” Roma said. “Besides, with all the physical work I do around the house and getting around by walking or riding my bicycle, I’m at peak health for my age. My doctor confirms it.”

“What do you do when you need a car?” Charles asked with a pounce.

“I drive my car,” Roma replied casually.

“How do you pay for gas?”

“It’s an electric vehicle.”

“How do you pay for electricity?”

“Solar panels.”

Charles threw his hands up in the air and shook his head in disbelief.

“Then you can afford to pay for health insurance!” he proclaimed.

“Charles,” she said squaring up on him with confidence. “Have I broken any of the rules of the State Income Support Division?”

“No.”

“Have I broken any laws?”

“No.”

“Yet, you look at me as a deviant, a vagabond, who is abusing the system,” Roma said.

Charles sat up and needlessly straightened his tie, “Eh, your case is a bit unusual.”

“Unusual doesn’t make it wrong,” she said.

“But our system has no way of fitting you into it,” Charles admitted.

“And there lies your problem.”

“I’m bound to what the system will allow,” he continued.

Roma stood, gathered her purse, and looked down on Charles.

“I’m sure you’ll figure it out,” she said, then turned and walked out of his office.

Three days later, a letter arrived in the mail which read:

Dear Ms. Frewinn,

        Upon review of your case #6087725117 we have determined that your health insurance subsidy is renewed.

State Income Support Division

Roma looked up from the letter, removed her reading glasses, and smiled. Stepping into the kitchen, she packed up a tin of fruit cookies from the several dozen which were cooling on the counter. She hand wrote a note, wrapped the entire package in brown paper, and addressed it to Charles. She weighed the package, calculated the postage, and put the necessary number of stamps on the package.

With the paper-wrapped tin and a small bag of three cookies in her arms, she dashed out the front door and across the street. The postal carrier was still there completing her deliveries for the neighborhood.

“Paulina!” Roma called out to the mail carrier.

The mail carrier saw Roma, smiled, and removed the wireless earbuds from her ears, “Hey, Roma! Whatchya got there?”

“Last minute package for you to post,” Roma said, slightly out of breath.

“Ooh! I’m sure this is delicious!” Paulina said. “I’ll be sure to hand cancel it for you so it doesn’t get damaged in the machine.”

“Thank you, Paulina. And these are for you!”

Paulina smiled at the bag of cookies then looked at Roma.

“Aww, you didn’t have to do that. I appreciate you, Roma.”

“I appreciate you, Paulina.”

As Roma returned to her house, she thought of the statement she adopted many years ago: People helping people, strangers helping strangers, neighbors helping neighbors. It has never failed her.