Roughly 11 million Americans enrolled in Medicaid still report having difficulty paying medical bills, according to data published by the KFF. Having a Medicaid card, it turns out, does not mean having complete protection — and for workers in physically demanding jobs, the distance between those two things can define everything.
I met Patricia Holloway on a Tuesday afternoon in late January 2026, entirely by chance. I had joined a Meals on Wheels volunteer crew in Charlotte, NC for a delivery ride-along, and one of the regular drivers mentioned a woman on her route — a young pest control technician who had recently started accepting the meal deliveries after a shoulder and nerve injury left her unable to work full shifts. That driver gave Patricia my contact information. Three days later, Patricia agreed to sit down with me at a coffee shop off Albemarle Road, and over about ninety minutes, she walked me through two years of financial damage that a Medicaid card was supposed to prevent.
A Routine Job, a Serious Injury, and a Bill She Didn’t Expect
Patricia Holloway has worked in pest control since she was 26. By 2024, she was earning approximately $28,400 a year — enough to cover her share of a two-bedroom apartment in east Charlotte and the payments on a 2018 Ford F-150 she needed to reach job sites. Then, in March 2024, a prolonged chemical exposure on a commercial account left her with peripheral neuropathy — nerve damage in her hands and forearms — that her occupational physician said was consistent with repeated organophosphate contact.
She qualified for North Carolina Medicaid, which the state formally expanded in December 2023 under the NC DHHS Medicaid Expansion program. Patricia enrolled in February 2024. She assumed, as many people do, that coverage meant her medical costs were handled.
What Patricia did not know — what nobody clearly told her — was that her Medicaid plan placed limits on specialist visits, did not cover the specific ergonomic wrist braces her neurologist recommended, and required prior authorization for the nerve conduction study that ultimately confirmed her diagnosis. That study was delayed by six weeks. During that time, she continued working reduced hours at about $11.80 per hour, the reduced rate her employer placed her on while she was on modified duty.
By August 2024, she had accumulated $4,200 in medical debt across three providers: her neurologist, a physical therapist, and a medical supply company. Medicaid had paid the majority of her costs — she estimates it covered roughly $11,000 in total claims — but the remaining balance was still more than she could absorb on a reduced income.
The Auto Loan That Became an Anchor
The truck was, as Patricia described it, both her lifeline and her biggest regret. She bought the F-150 in late 2021 with a $3,500 down payment and a 72-month loan at 14.9% interest through a subprime lender — a rate she accepted because her credit score at the time was 581. As of January 2026, when I spoke with her, she still owed approximately $14,800 on a vehicle that Kelley Blue Book listed at roughly $8,300 in fair condition.
She owed $6,500 more than the truck was worth. Selling it was not a realistic option without cash to cover the gap, and refinancing had been declined twice because of her current credit score — now sitting at 548 after the medical debt hit her report. She needed the truck to work. She could not afford to keep it. She kept making the $387-per-month payment because missing it felt worse than making it.
“I’ve done the math probably fifty times,” Patricia told me. “Every time I do it, I end up in the same place. There’s no version of this where I come out ahead right now. I just try to get to the next month.”
Applying for SNAP: A Process She Almost Abandoned
In October 2025, a coworker told Patricia she might qualify for SNAP benefits. Patricia had dismissed the idea earlier because she assumed her job disqualified her. Her gross monthly income — including the disability supplement she received from her employer’s workers’ compensation carrier, about $340 per month — had fluctuated enough that she wasn’t sure where she stood.
She submitted a SNAP application through the NC ePASS portal in early November 2025. The process required documentation of her income, her lease agreement, proof of the auto loan balance, and a phone interview that she missed the first time because her shift ran long. She rescheduled. The second interview lasted about twenty-two minutes.
She was approved on December 9, 2025, for $214 per month in SNAP benefits. The retroactive payment for November and December arrived on her EBT card before Christmas. “I cried a little,” she told me. “Not because $214 is a lot. It’s not. But it meant I didn’t have to decide between groceries and the electric bill that month.”
What the Benefits Covered — and What They Still Don’t
Patricia’s monthly expenses, as she walked me through them, came to roughly $2,480: $620 for her share of rent, $387 for the truck payment, $218 for insurance on the vehicle, $190 in utilities, approximately $140 in gas to reach job sites, and various smaller costs. Her take-home pay as of January 2026 was approximately $1,920 per month, supplemented by the $340 workers’ compensation supplement — totaling around $2,260. The gap was not catastrophic, but it was persistent.
Medicaid continued to cover her neurologist visits and her physical therapy co-managed through Atrium Health. But the $4,200 in prior debt remained largely unpaid. One provider had sent it to collections in September 2025. Patricia said she had spoken with the collections agency once and had not called back.
Her disability supplement from the workers’ comp carrier was scheduled to end in April 2026, when her physician was expected to clear her for full duty — or formally declare a permanent partial impairment. Patricia told me she was uncertain which way that evaluation would go. If she returned to full duty, her income would recover slightly. If the impairment was classified as permanent, she would need to navigate a separate set of claims that she described as “a whole other nightmare I haven’t started yet.”
Where Patricia Stands Now — and What She Wants People to Understand
When I followed up with Patricia by phone in early March 2026, not much had changed structurally. She was still making the truck payment. The SNAP benefits were still coming. The medical debt was still in collections. Her workers’ comp evaluation had been pushed back to May 2026 at the request of her employer’s insurance carrier.
She had, however, done one thing. She found a local nonprofit — Crisis Assistance Ministry in Charlotte — that offers one-time utility assistance and connected her with a volunteer advocate who was helping her request a hardship review of the medical debt through one of the hospital’s financial assistance programs. As of our last conversation, that review had not yet produced a result.
Patricia told me she would describe her situation not as a crisis but as a slow grind — a phrase that felt precise and honest for someone who genuinely plans ahead but runs low on the energy to execute those plans. She had a list on her phone, she said, of things she was going to do: call the collections agency back, look into income-driven repayment for the truck through a nonprofit auto lender, ask her case worker about expanded Medicaid coverage for her equipment. The list was long. The days were short.
I left our conversation thinking about the quiet distance between having a benefit and having enough. Patricia Holloway is not someone who fell through the cracks through carelessness. She worked her way into a corner that a series of systems — an injury, a loan, a coverage gap, an evaluation delay — built around her one decision at a time. The SNAP card helps. The Medicaid card helps. And she is still, as of this writing, $6,500 underwater on a truck she cannot afford to keep and cannot afford to lose.
Related: A Raise Didn’t Save Her: How Lifestyle Inflation and One Medical Bill Sent a Birmingham Mom Into Debt
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