Guam – At least one senator is making a call for Medicare coverage in the Philippines in light of a recent announcement that Medicaid will soon be approved in the country. PNC met with one Medicare recipient who agrees with the senator.
Meet Rodney Calimlim. He’s 38 years old and cooks and cleans. By all accounts normal, but he’s also got a host of conditions that prevent him from living a normal life.
“I have diabetes, I have end stage [renal disease], I go to dialysis, I have CHF, which is congestive heart failure, and I’m blind,” said Calimlim.
Rodney was 32 when he became blind and just 33 years old when his kidneys failed, forcing him to undergo dialysis three times a week. Now, he’s on a kidney transplant list in Hawaii.
Forced out of work, Rodney has no choice but to depend on the government in order to survive. He receives Social Security disability income, is a Medicare recipient, and is now on Guam’s MIP.
Soon, Rodney will have to go to Hawaii for an angiogram, a procedure that will assess his heart condition to prep him for a kidney transplant when it becomes available. While Medicare will pay for 80 percent of the procedure, Rodney will have to come up with the other 20 percent, plus airfare.
“I got an email from the transplant team in Hawaii–her name is Shonda–and she said that for the whole two weeks that I’m gonna be there for the procedure… I have to pay between $5,000 to $7,000,” he said.
Rodney is faced with having to raise funds for his medical trip. But now he’s faced with an even greater challenge now that he’s been pushed out of Medicaid.
“In August I was switched from Medicaid to MIP according to [the Department of Public Health and Social Services]. It’s because of my Social Security disability income, it exceeds the eligibility for Medicaid,” said Calimlim.
Rodney’s disability income went up by a meager $30 dollars, a stark contrast to the jump in expenses for his numerous medications, even with MIP coverage—about $500 a month.
“Before I wasn’t paying anything for my medications when I had Medicaid, but this time there is a percentage that I do have to pay [under MIP] that I can’t even afford because I’m taking a lot of medications for my diabetes, medication for my kidney failuire, and medications for my congestive heart failure, and also for blood pressure,” explains Calimlim.
It’s patients like Rodney who could benefit from a Medicare approved facility in the Philippines. Health Committee Chairman Sen. Dennis Rodriguez says he’s pushing for the issue.
While he’s happy with the recent announcement that the Centers for Medicare and Medicaid have agreed to allow Medicaid patients to seek treatment in Manila, Rodriguez says Guam residents will benefit if the same could be done for Medicare patients.
“Ultimately what I think we need to push for is for our Medicare patients to be able to be seen in hospitals in the Philippines. I’ve talked with a lot of our man’amko who wish that they can travel three hours rather than seven or 11 hours elsewhere,” said Rodriguez.
If Medicare coverage could be approved for Guam patients in the Philippines, Rodney says the government could also save money by sending him there for a kidney transplant than in Hawaii. Having done his own research, Rodney says in the Philippines, a kidney transplant at a Joint Commission accredited facility would cost about $20,000 US dollars, or roughly 1 million pesos.
For Rodney, that would mean paying $4,000 out of his pocket for a transplant while Medicare would cover the rest. However, the cost in Hawaii is much more.
“I know from Hawaii’s procedure it costs between $200,000 to $300,000,” says Calimlim.
Even at the minimum, Rodney would still need to raise about $40,000 out of his pocket to pay for a kidney transplant without secondary insurance coverage. But without any alternative, for now, Rodney must come up with about $5,000 to $7,000 for an angiogram to be on the transplant list. And with only MIP as his secondary insurance, he’s challenged with raising the funds for his medical trip because of the increase in his monthly expenses.24
Sen. Rodriguez says he’s working with Congresswoman Madeleine Bordallo’s office to see how Guam’s Medicare patients could get coverage in the Philippines.