Nan Macklin: A Community Health Worker's Fight to Protect Medicaid in Rural Missouri

Nan Macklin is a Community Health Worker in the Bootheel region of Missouri, serving families who rely on Medicaid and Medicare. She works with seniors and small children in one of the poorest counties in the state. Nan explained that between 80-90% of the patients she serves rely on some form of state assistance, “I work in the community with families, faith-based and all, to help them find those resources that will help them live a better and healthy life.”

Her connection to Medicaid is personal as well as professional. As a single mother, she utilized Medicaid for her daughter’s health care. She recalled, “I was able to take her to the doctor, get the shots, necessary shots, and immunizations that was needed for her to start school.” This coverage was even more critical when her daughter fell ill and had to be hospitalized. “I was able to take her to the doctor and not have to pay and not have to worry about whether she was going to get the medicine needed when she left the hospital because Medicaid covered [it].

Nan continues to see how critical Medicaid is for families like hers today, providing essential support even beyond medical care. Nan explained, “I work in an area and live [where] we don’t have public transportation, nor do we have Uber or none of those sources, you have to have a car or know someone to have a car.” With some doctors as far as 100 or 200 miles away from where her patients live, Medicaid’s transportation support is a determining factor in their ability to access care. Nan cited one of her patients as an example, “She is a dialysis patient and has to go to St. Louis quite often. And without that Medicaid piece that would pay for her transportation, she wouldn’t be able to go.”

Beyond just access to care, Nan continues to see families faced with challenges understanding their benefits, “One of the other challenges that we face when it comes to Medicaid and a barrier is them being able to understand their benefits, understanding the language behind, ‘Do I qualify for this?’ or ‘I’m a certain age, do I get this? Do I get that?’ those are some of the barriers and the challenges that the older senior citizens face as it relates to Medicaid and how they access their benefits.”

Nan spoke about the difficulties patients face trying to stay enrolled in the program. “We’ve already experienced that some [patients] went to the doctor and didn’t know that their coverage was out until the receptionist came back and said, ‘You no longer have coverage, you can’t see the doctor.’ … And they didn’t know because they had moved, so they didn’t get that re-certification letter. And in turn, that brought on anxiety.”

As Republican health care cuts begin implementation and more eligibility checks and red tape are added to the process, many families will struggle to maintain their coverage as well as their access as rural hospitals and clinics close due to lack of funding. Nan warned about the consequences of these closures. “It would devastate this area,” she shared.

To members of Congress who do not see the value in these services, Nan shared, “I would say to the one that doesn’t think Medicaid nor Medicare is important, then they haven’t walked in the person’s shoes that it benefits … Please take in consideration that what if it was you? What if it was your family that was [sick], and you had a decision to make, what would it be?”