A year ago, ‘Ele’ele resident Jonnie McCarroll hoped to get Medicare and Medicaid to cover a life-saving liver transplant surgery in Hawai’i, but he says his attempt is being thwarted by red tape. The medical-health programs for the elderly and
A year ago, ‘Ele’ele resident Jonnie McCarroll hoped to get Medicare and Medicaid to cover a life-saving liver transplant surgery in Hawai’i, but he says his attempt is being thwarted by red tape.
The medical-health programs for the elderly and ill don’t cover such operations in Hawai’i, only in the mainland.
His condition has worsened since last year, McCarroll contends, and his chances of getting that operation now seem more remote.
Because he is divorced and single, the state Department of Human Services is now requiring him to cover a $614 monthly co-payment to maintain his Medicaid benefits.
Welfare covers 80 percent of his medical bills, but McCarroll needs to have the Medicaid coverage of 20 percent to pay for the surgery.
Without the coverage, he could lose his place on a list for transplant surgeries at the UCLA Medical Center in California and reduce his chance of prolonging his life, McCarroll said.
McCarroll has filed two appeals with the Med-Quest Division with the state Department of Human Services to give him an exemption from the co-payment and maintain his benefits.
He also has contacted Sen. Daniel Inouye for help.
A representative of the agency, Elizabeth Ahana, said the agency sympathizes with McCarroll’s situation.
However, the agency can’t comment on the issue because a decision on the appeal is pending, she said.
Medicaid is a joint federal and state program that helps pay for health care for the needy, aged, blind and disabled. Low-income families with children also qualify for benefits.
Medicare is a federal health insurance program for people who are 65 years and older and disabled.
McCarroll said his problems began after his divorce in May 2001.
On March 7, McCarroll received a notice from the state agency that his share of the monthly medical cost would increase, effective in April, because of the divorce.
With the help of Kaua’i attorney K.D. Swinburnson and another attorney, D. McCarthy, McCarroll contested the decision.
Following a hearing May 13, the state agency determined McCarroll’s co-payment was appropriate because his household decreased from two to one as a result of the divorce.
McCarroll, who receives only $1,032 in monthly social security disability benefits, said if he agrees to the co-payment, he would be assured of the Medicaid benefits, but would not have enough money for food, rent and utilities.
“I already pay $900 a month for rent. How can I afford $614?” McCarroll asked.
Agreeing to cover the co-payment amount also could force McCarroll to seek out medical services unnecessarily, wasting government funds, said his girlfriend, Dianne McCarthy.
Without full coverage by Medicare and Medicaid, the UCLA Medical Center, which can perform the liver transplant, will not take on his case, McCarroll said.
“They want to know whether I can cover the full cost of the surgery and the drugs (to help the body accept the new liver),” which comes out to about $8,000 a month for the first six to eight months after the surgery,” McCarroll said.
The California medical facility, he said, is ready to take on his case because “I am a good candidate,” McCarroll said.
“I have done all the tests. I have been sober for 16 years,” he said. “UCLA wants a patient who is going to take care of a new liver. I will.”
McCarroll, a power engineer and an energy conservation expert, said he worked for electrical supply companies on Kaua’i after moving to the island from O’ahu in 1989.
He was laid off from his last job, ending his private health insurance.
No insurance company will cover him because of his condition, McCarroll said.
McCarroll also said his social security benefits offered through Medicare and Medicaid will only cover a liver transplant on the mainland, not in Hawai’i.
In order for liver transplants to be covered, the St. Francis Medical Center on O’ahu must be certified by the United Network of Organ Sharing.
It is a government agency that monitors the performance of transplant facilities in the United States.
The Health Care Administration, which is part of the U.S. Department of Health Care and Human Services, currently requires 12 liver transplant surgeries be performed each year before a facility can be certified.
Because the St. Francis Medical Center averages only 10 to 11 liver transplants a year, the facility doesn’t meet the requirement.
However, the O’ahu medical facility is asking for an exemption from the required 12 liver transplant surgeries, citing Hawaii’s geographical isolation, said Donna Pacheco, an official with the Transplant Institute at the O’ahu medical center.
“We are pretty much dependent on the local donor…The population is small,” Pacheco said.
Because of all the obstacles, McCarroll’s said his only chance of getting lifesaving surgery is to become deathly ill, thereby making him eligible for emergency transplant surgery in the mainland.
“I don’t have much time left,” McCarroll said. “I am trying to hold up as best I can.”
Staff Writer Lester Chang can be reached at mailto:lchang@pulitzer.net or 245-3681 (ext. 225).
