Editor’s Note: A previous version of this article stated Tulane has never accepted Medicaid as a form of insurance. Tulane accepts in-state Medicaid as an acceptable way to waive the T-SHIP requirement.

Tulane Campus Health and most college health centers across the country have not accepted out-of-state Medicaid as a form of health insurance for students since the program’s introduction in 1965. These policies can disproportionately affect lower-income students who use Medicaid as their primary insurance. 

The rules and regulations for Medicaid differ widely from state to state, so trying to accommodate differences in Medicaid coverage across 50 states at a small college health center can be difficult. As low-income students are enrolling in college at a higher rate than ever before, more students are affected by health center’s Medicaid policies every year. 

I'll tell you a story about that… i remember having to choose b/w going to university for bachelor's while not having health insurance (medicaid) and going to college for 2-year degree while being able to keep my health insurance… couldn't have both no no no https://t.co/AyI9J5gdrG

— Minorities in STEM (@MinoritySTEM) September 25, 2019

Most universities require health insurance coverage, and Tulane is no exception. Students are required to purchase the Tulane-sponsored Student Health Insurance Plan or provide proof of insurance. Tulane Campus Health, however, has never accepted out-of-state Medicaid as a way to waive the T-SHIP. Students must either purchase T-SHIP or find an outside insurance plan that meets the requirements. 

“Medicaid is state specific — meaning, if you have Medicaid in Florida, it is only good in Florida,” Scott Tims, assistant vice president of Campus Health, said. “That’s why it doesn’t meet the requirement for [a] waiver. We have a lot of out of state insurance plans that don’t provide care when you are away from home, thus not meeting the waiver requirement.”

In-state Medicaid is able to waive the requirement, but can not be used at the campus health center. The campus health center works with students on Louisiana Medicaid to find off campus providers. 

For Louisiana students, a Health Insurance Premium Payment program could be used to work with students on Louisiana Medicaid. In Montana, payment is issued directly from the state Medicaid office to the institution through their HIPP program. Similarly, at Cornell University in New York, the state Medicaid program will pay the student health plan premium and leave Medicaid coverage in place as secondary coverage to fill in any gaps in the student plan.

Tims said Campus Health is working toward introducing this type of premium payment program as an option for students, which would allow Louisiana’s low-income freshmen with families on Medicaid to apply to a Louisiana HIPP program to have their student insurance covered.

“Putting more money towards students who really need those dollars is something that is very close to my heart,” Dean of Undergraduate Admission Satya Dattagupta said in an interview with The Hullabaloo last year, addressing Tulane’s increasing of need-based aid. “I come from a low-income family myself, and college would not have been a possibility if I hadn’t received aid.”

Children’s Health Insurance Program (CHIP) policies end when students turn 19. In states where Medicaid is expanding coverage, if individuals are not listed as dependent on their family’s tax returns, it is possible for individuals to apply for Medicaid if they make less than 133% of the poverty line. Most students over 18 are dependents on their family’s tax returns, however, so this option is limited.

The Department for Health and Human Services advises that Medicaid is usually used for pregnant women, minors, people who are aged, blind or disabled, and “other situations” where people are leaving welfare. While this list does not include low-income and dependent college students, Tulane undergraduate and graduate students who are still on the federal Medicaid program under various circumstances are affected by Tulane’s policy. 

Junior Kennon Stewart receives Medicaid benefits and believes the problem is not based on the political debate behind Medicaid. 

“This is about the fact that [Medicaid] caters specifically to lower-income people and Tulane banning its use is a direct attack on students like myself who can’t afford T-SHIP,” Stewart said. “And with the copays associated with the Tulane-sponsored option, it only succeeds in making sure I don’t see a doctor until I graduate.”

Students from lower socio-economic backgrounds are not able to purchase healthcare as easily as their wealthier classmates. Offering T-SHIP coverage for students who have qualified for Pell Grants could provide a streamlined way to prove students’ low-income status and set a clear standard through the federal evaluation. 

Institutions like Williams College, the University of California Santa Cruz and Smith College have taken similar steps to ensure all students have coverage. These universities each have their own rules for their health grants. 

For example, Williams offers to “cover the full cost of health insurance for financial aid recipients who do not have health insurance or whose health insurance does not meet the college’s requirements for coverage.” 

As Tulane makes an effort to accept more low-income students, there is a clear need to provide options to ensure all students have an equitable experience and have access to health care during their time on campus.

A grant application process to cover Pell-eligible students’ health insurance could also be used for low-income students, and on-campus offices such as the Center for Academic Equity and The Carolyn Barber Pierre Center for Intercultural Life could facilitate this type of program. This type of program would provide students with grant-writing experience but may also put more strain on already disadvantaged students.

Without Medicaid as an option as of now, students and faculty look to other options to provide Pell-eligible and other low-income students with adequate health care coverage. 

“We recently held a call with another group who lobbied for a change in the program for their state,” Tims said. “We are hoping to be able to do something similar here.”

Correction: A previous version of this article stated that Medicaid policies end when students turn 19. Children’s Health Insurance Program (CHIP) policies end at 19, not Medicaid.