The state of healthcare services for the homeless

... but half the battle is finding them.

click to enlarge PAPER TRAIL: Linda Mariano pages through medical bills as her boyfriend, Bobby "Mad Dog" Donahue, looks on. - Sarah Gerard
Sarah Gerard
PAPER TRAIL: Linda Mariano pages through medical bills as her boyfriend, Bobby "Mad Dog" Donahue, looks on.

Linda Mariano is 57 years old and 95 percent deaf. She can see without glasses, she says, but she can't read without them. Pyorrhea has rotted away most of her teeth. She has a hole in her skull the size of a silver dollar, where she was hit in the head with a brick at the age of 17 ("or 18").

I talked to Linda for over an hour the other night, sitting on the sidewalk outside the Open Air Post Office in St. Petersburg, where she's been homeless for almost seven years with her boyfriend, Bobby "Mad Dog" Donahue. As we were talking, she took her shoes off and set them next to us. I looked down at her feet. Her toes are swollen and bent, so wearing shoes is difficult. The arthritis in her knees makes it painful to walk around much, and sleeping on the concrete doesn't help.

She's never held down a job because of her learning disability. "I'm not able to work," she said, "because the fact is, I have got a learning disability and memory relapse and I can't remember too far back, and it takes me, gosh, forever to learn to do anything, so I'm really slow on anything, so I can't really keep a job."

Linda's teachers told her she had the "learning level" of a third grader. "Ever since I was little," she says, "I was going to special education classes." She didn't finish high school.

Linda used to have Medicaid, when her daughter was living with her, but lost it when they both became homeless. Her daughter was 14 at the time, and went to live with a friend. Linda wound up on the streets, and her Medicaid stopped. She's reapplied three times, and doesn't understand why they keep telling her she's ineligible.

"That don't even make no sense," she says. "I'm 57 years old and still can't get Medicaid. I can't get nothing done. Can't get my ears checked on, can't get my eyes checked on, or teeth or nothing because they won't give me my Medicaid. My teeth are rotting out and breaking, and I can't get them fixed because the fact is that I can't get Medicaid."

I left the interview thinking, "What the hell? Why can't this woman get Medicaid?"

So I decided to find out. In fact, many healthcare options are available to her, including Medicaid. But in order to take advantage of them, she has to navigate government lingo and public health bureaucracies — and that's not an easy task, especially for someone with the learning ability of a third grader.

Linda says she applied three times for Supplemental Security Income (SSI), a federal income supplement program funded by general tax revenues, to help people who are blind, elderly or disabled, but was turned down.

According to Section II, page 10 of the Florida Medicaid Summary of Services handbook, if you're eligible for SSI, you're automatically eligible for Medicaid: "All Supplemental Security Insurance (SSI) beneficiaries residing in Florida are automatically entitled to Florida Medicaid with full benefits. To be eligible for SSI, an individual must be age 65 or older (or if 64 years of age or younger, be totally and permanently disabled) and meet SSI income and asset limits."

We can pretty much assume that she meets the income and asset limits, right? Who knows if she's considered totally and permanently disabled. Oh, wait...

The SSI eligibility FAQ webpage says that an adult is considered disabled if "he or she has a medically determinable physical or mental impairment which ... results in the inability to do any substantial gainful activity; and can be expected to result in death; or has lasted or can be expected to last for a continuous period of not less than 12 months."

She has taken her case to Gulfcoast Legal Services, a non-profit corporation providing free legal aid to people like her. But Gulfcoast is so backed up, they told her, she'd have to wait 18 months just to go to court. Until then, she sleeps on the sidewalk.

One administrator at Family Resources, a non-profit social service organization for children and families, says that's not unusual. "Especially with disability (SSI), it's gotten more difficult to get it because, I mean, you're almost routinely turned down the first time and then you have to appeal and appeal. There's a big backlog of cases, at least a year. If you eventually get it, they'll back pay to when you first applied."

Bobby and Linda told me they had gone to the Pinellas County Health Department to see a doctor, and were told that they couldn't get a primary care physician because they didn't have an address. "That's what they told me and her," says Bobby. "If we didn't have an address, they couldn't do nothing for us."

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