As someone who relies on SNAP and Medicaid to survive, Lisa Lockley says she often feels like she’s walking a tightrope every month as she tries to avoid exceeding the income limits for those programs while still earning enough to pay her bills. Lockley has learned the hard way that one miscalculation or slightly higher-than-normal paycheck means she might lose the benefits she desperately needs. 

Income limits for safety net programs can feel like a trap that keeps people stuck in poverty and unable to get ahead. These arbitrary restrictions are often much less than what someone would realistically need in their area to cover basic expenses like shelter, food, and utilities, let alone put anything away for savings. The often relatively small dollar amount that can push someone over the eligibility cutoff can have a disproportionately big impact. Someone who exceeds the Medicaid limit by a few hundred dollars, for example, may not be able to find any other health insurance options they can afford – which means they could potentially be on the hook for hundreds (or even thousands) of dollars in medical bills if they should become sick or injured. 

For people like Lockley who are enrolled in income-based safety net programs such as SNAP and Medicaid, it can seem like each month brings the struggle to hit that “just right” point where you make as much money as possible to pay the bills while at the same time keeping your income just below the line of program eligibility. 

Walking this delicate line is especially challenging when the eligibility guidelines aren’t always clear. The rules for these programs are notoriously confusing, vague, and frequently changing. 

Lockley, 58, of Bath, Pennsylvania, works as a caregiver for people who have mental or physical challenges, going to their homes and assisting with their daily living needs and activities. She has also worked as a hospice caregiver in the past, and at one point was working 71 hours a week – which caused her to lose her medical coverage through Medicaid. 

For Lockley, who has diabetes and other medical issues, losing health insurance coverage is a dangerous situation that could put her life at risk. 

“I’ve been where I did my recertification that you do every six months, and they said I made $121 a year too much — $121 a year – and therefore I was losing my medical. I was able to get my doctor to write a letter to them saying I need this life-sustaining medication and that I have to have some kind of coverage.” 

Seeking a way to help Lockley keep her medical coverage, her caseworker enrolled her in the state’s Medical Assistance for Workers with Disabilities (MAWD) program, which has higher income limits than traditional Medicaid but requires participants to pay a monthly premium. Lockley’s premium was $40 a month – but her budget was stretched so thin that even that was more than she could afford, so she was cut off from the program when she couldn’t make the payments. 

Lockley’s work schedule and monthly hours often fluctuate, which means her income does, as well. She has been on and off Medicaid and SNAP multiple times. Sometimes she will try to strategically plan the gaps, risking going without medications and medical visits during periods when she wants to try and get caught up financially. 

“It’s always a catch-22 situation,” she says. “If I’m working enough to be financially stable, then I lose my medical coverage, but I’m not making enough money to pay for these doctor appointments out of pocket or even my medications. So then I’m like, ‘Okay, well, I have to work less hours because I’m in a lot of pain now, and I know I have to go to a doctor, so now I have to cut back my hours so that I can get my medical again.’ And then once I address them, I’m feeling a little better and think I can work more hours so I can catch up on the bills and my medical again. And it’s a cycle.”

Navigating income eligibility limits is a challenge that many families who rely on safety net programs face. Most households that receive SNAP benefits have at least one person who is working, and nearly 2/3 of all Medicaid recipients work. 

This could soon become a concern for an increasing number of people, as Republican lawmakers ramp up their efforts to push for Medicaid work requirements. In states where these policies are put in place, many participants may be required to work a certain number of hours to remain eligible while at the same time keeping their income under a certain amount. It can often feel like an impossible balancing act. Program participants like Lockley can feel like hamsters stuck on a wheel, with no way to break out of the cycle or improve their financial situation without jeopardizing the critical support resources they need for daily survival. 

Income limits that more realistically reflect the cost of living in a specific area would help, as would some flexibility that allows participants to have an occasional higher-earnings month or put funds into savings without that money counting towards the income limit. Without any policy changes, these income caps for safety net programs will mean the cycle of poverty will continue in many low-income families. Of course, in a perfect world, we’d have something like universal healthcare, which would allow all Americans to have access to healthcare as a given, without being forced to perpetually jump through endless hoops to confirm eligibility. Sadly, Republican lawmakers have made it clear that they will block any move towards universal healthcare, making it seemingly impossible anytime in the near future. 

On a positive note, our movement to make healthcare more accessible and affordable is gaining momentum and growing. This is a cause with strong public support, as the public supports expanding access while also giving our healthcare system a much-needed overhaul. So we’re going to continue fighting to help make healthcare a basic right that’s available to all Americans, as opposed to being a luxury only those with financial advantages can afford.