What Medicaid Coverage Actually Looks Like
My-Lan Truong has been covered by Medicaid her entire life. In this blog post, she shares what that coverage has meant in practice.
I am a first-generation Vietnamese American, raised in a low-income, single-parent household in Tacoma, Washington. I have been covered by Medicaid for all of my life, and I want to share what that coverage has actually looked like in practice because the gap between what Medicaid promises and what it delivers is something policymakers rarely see from the inside.
When my mother almost died, her coverage had lapsed. During my freshman year of college, my mother was hospitalized with a severe liver abscess that ruptured before it was properly diagnosed, causing a bloodstream infection that brought her to the edge of sepsis. She spent weeks in the hospital, underwent emergency surgery, and required months of post-discharge care including home visit nurses, weekly antibiotic deliveries, and follow-up appointments across multiple specialties.
Her Medicaid coverage had lapsed at the time of her hospitalization. My mother speaks no English. She could not navigate the system herself. I became her sole advocate, spending fourteen or more hours a day at the hospital as her translator, and simultaneously spending weeks on hold with insurance agents, being transferred from representative to representative, receiving different answers each time, never knowing whether the hundreds of thousands of dollars in medical bills accumulating around us would be covered. We were already low income. The possibility of $200,000 in debt while my mother lay recovering in a hospital bed was not abstract. It was a number I carried every single day of those weeks.
We eventually secured coverage retroactively. But the process was not designed for people like us, people without English fluency, without prior experience navigating bureaucratic appeals, without the time or resources to spend hours on hold while simultaneously managing a medical crisis. If I had not been there, bilingual and persistent, I genuinely do not know what would have happened.
When I turned 18, I had to apply for my own Medicaid coverage independently. The process was confusing enough that I experienced a coverage gap simply from not knowing how to navigate the transition, and I am a native English speaker. I cannot imagine how that process feels for someone in my mother’s position.
For the past eight years, I have not had an eye exam, glasses, or contact lenses. My childhood optometrist retired and closed her practice, and I have not been able to find a single clinic within my area that accepts Medicaid for vision care and is accepting new patients. For eight years. Not because I haven’t looked, but because there is simply no room.
Dental care has followed the same pattern. After more than two decades with the same dentist, that practice stopped accepting Medicaid. I have not seen a dentist since. Finding a provider who both accepts Medicaid and is taking new patients has proven effectively impossible in my area, despite persistent effort.
This is what Medicaid coverage looks like for many of us on the ground, not a safety net, but a system we are constantly trying to find our way into, while being told there is no room, no availability, no new patients accepted.
On work requirements: I am currently a pre-nursing graduate, a hospital recognition program coordinator, an emergency department volunteer, and a patient advocate ambassador. I meet any reasonable definition of an engaged, contributing community member, but I want to be clear. The people in my community who would struggle most to document work requirements are not lazy or disengaged. They are people like my mother, working sixty to seventy hours a week in jobs that don’t offer documentation, navigating systems in a language they don’t speak, spending every available hour surviving rather than filing paperwork.
Work requirements don’t filter out people who aren’t contributing. They filter out people who don’t have the infrastructure to prove it. That is not the same thing, and policymakers should not treat it as such.
I am sharing this because I have seen what happens when the system fails people who cannot advocate for themselves. I have stood in a hospital hallway and fought for my mother’s right to be heard and believed and treated. I am training to become a nurse so I can keep doing that work, one patient at a time.
But no individual nurse can fix a system that leaves people without vision care for eight years, that lapses coverage during a medical emergency, that requires a bilingual college student to spend weeks on hold to prevent her mother from being buried in debt after nearly dying.
That requires policy. And policy requires hearing from people like us.
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My-Lan Truong is an NPAF grassroots ambassador and a nursing student living in Tacoma, WA.
