"Six dollars too much": Inside a Bedford County woman's fight for a kidney transplant

BEDFORD COUNTY, Va. (WDBJ7)-- Last year in Bedford County, more than 4,000 people applied for Medicaid. According to Andrew Crawford, Director of Bedford County Social Services, 2,150 applications were accepted.

Kimberly Taylor, 43, was one of 2,400 who were denied. She makes just enough to not qualify, but not nearly enough to pay for a surgery she desperately needs.

Three years ago, after 13 years of work as a nurse in Roanoke, Taylor’s diabetes and gastroparesis made her unable to work. She was later told her kidneys were failing.

Now, Taylor spends three days a week, three hours a day in dialysis. Most days she just rests.

"I just really wish I could back in time and be done with this and go back to work,” said Taylor. “Not sure what's going to happen."

What stands in Taylor's way is not a kidney, she has a potential donor. She can’t get enough health coverage for the surgery.

Taylor currently has Medicare A, B and D. Medicare only covers about 80 percent of a transplant surgery, according to University of Virginia Health Systems.

In a letter to Taylor, UVA said she is required to have the remaining funds, somewhere between $10-15 thousand, available before the surgery takes place.

Taylor said she doesn't know how she would come up with those funds. Her husband and her are both disabled and only receive social security.

Medicaid would cover 100 percent of the surgery. After being denied five times for regular Medicaid, Taylor applied for a different type of Medicaid this summer.

She applied for Medicaid LTC, or Long Term Care coverage, which is for people who are more medically needy.

Taylor met the resource limits for Medicaid LTC, but she was over the allowable income. The income threshold she had to meet was $2,250. Taylor's income from social security is $2,256.

“Six dollars stands in the way of me and a kidney,” said Taylor.

It's her most recent barrier, but according to Bedford DSS, she does have options.

Taylor is eligible for what is called a “spend down.” If Taylor incurs medical bills amounting to about $1900 a month, she can turn the bills in and she would qualify for Medicaid LTC.

The spend down does come with some financial risk. If Taylor does not meet the spend down amount, she could become liable to pay the bill. It’s a financial risk Taylor said she can’t afford to take.

Taylor inquired if she could reduce her income from social security.

“The local Department of Social Services does not determine one’s social security/disability amount. The Social Security Administration does that based upon their roles,” said Dannielle Tosh, Benefit Programs Manager for Bedford DSS. “So when an individual comes in and they are getting their social security, it is what it is to us. And we have to go by the amount that they are getting and apply that to our income and resource guidelines based upon our Medicaid policy.”

Even if Taylor were not six dollars over the limit, she would still have to pay a co-pay of about $1,000 to receive full coverage Medicaid LTC. The co-pay is based off of how much a person’s income exceeds the personal needs limit.

Bedford County DSS says Medicaid expansion will not affect Taylor's eligibility for this type of coverage, but she is encouraged to apply again in March, just in case.

"Everyone has a story. You want to do everything in your power. You feel their pain and you're dealing with them, you're talking to them,” said Tosh. “But at the end of that day it all boils down to whether or not they meet that income and resource limit as to whether or not we can give them Medicaid or not."

The DSS team is still working her case to see if she fits in a different category.

“We look at every little thing a person has and when you see a person is close to a limit...there's nothing you can do,” said Tosh.

According to Virginia Department of Medical Assistance Services, Virginia's eligibility rules are among the strictest in the nation.

It’s a fact that leaves Taylor’s husband, Carl, feeling helpless.

"I do whatever I can. I'd kill for her, but there ain’t nothing I can do for this,” said Carl Taylor.

Taylor will continue to go to dialysis three days a week, three hours a day. She will hope for a change in her case. She will look into a fundraising company UVA endorses and keep on fighting until she can't.

"The option is you either do it, or you're not around,” said Taylor. “So I have to do it."