Most people assume that government health programs are reserved for the unemployed or the deeply impoverished. Theresa Castillo is proof that the working middle — people with steady jobs, graduate degrees, and real household responsibilities — can find themselves equally stranded, staring at a Medicaid application and wondering how it all unraveled so quietly.
I met Theresa on a Tuesday morning in February 2026, in the waiting room of the Social Security Administration field office on Rockside Road in Cleveland. I was there reporting on processing delays for disability applicants. She was there for something else entirely — trying to get documentation sorted for a Medicaid application she had submitted six weeks prior with no response. She sat with a manila folder on her lap, a reusable coffee mug, and the particular stillness of someone who has run out of urgency.
When I introduced myself and explained what I was working on, she gave a short, tired laugh. “You should write about this instead,” she said, gesturing at her folder. So I did.
A Budget Built on Overtime That Disappeared
Theresa Castillo is 27 years old and drives a school bus for the Cleveland Metropolitan School District. She has been doing it for three years, since returning to Cleveland after finishing her master’s degree in Education Administration at Cleveland State University. The degree cost her roughly $42,000 in federal student loans. The job pays approximately $34,000 a year in base salary — no employer-sponsored health insurance, a fact she knew when she accepted the position but believed she could manage.
What made the math work, she told me, was overtime. Between early-morning routes, afternoon runs, and supplemental trips for after-school programs, she was pulling in an additional $380 to $420 per month. That money covered her income-driven student loan payment of $312 per month and left just enough to contribute toward a marketplace health plan she had enrolled in through Healthcare.gov.
In January 2026, the district cut supplemental transportation contracts due to a budget shortfall. The overtime evaporated almost overnight. Theresa’s effective monthly take-home dropped from roughly $2,800 to $2,410. Her marketplace premium for the family plan — covering herself, her husband Marcus, and four kids between the two of them from prior relationships — was $618 per month after the advance premium tax credit she had been receiving.
“I did the math at the kitchen table one night and just sat there,” she told me. “After the loan payment and the insurance and groceries and rent, there was nothing. I mean literally nothing left for anything going wrong.”
Ohio Medicaid and the Income Cliff Nobody Warns You About
Theresa’s first instinct was to apply for Ohio Medicaid. Ohio expanded Medicaid under the Affordable Care Act, and eligibility for adults is set at 138 percent of the federal poverty level. For a family of six in 2026, that threshold sits at approximately $54,900 annually. Theresa and her husband Marcus, who works in retail earning about $26,000 a year, have a combined household income of roughly $60,000 — clearing the Medicaid cutoff by just over $5,000.
She was not eligible. Not for full Medicaid. The children qualified for CoverKids, Ohio’s CHIP program, which was a genuine relief. But for Theresa and Marcus as adults, the state had nothing to offer.
According to Ohio Medicaid, the income-based eligibility rules follow federal ACA guidelines, and household size is a central factor in the calculation. For Theresa, every child in the home counted toward the household size — which helped her kids — but the combined adult income still pushed the adults just over the line.
“I felt stupid,” she said. “I have a master’s degree. I should have understood this. But nobody explains that there’s a cliff. You’re just slightly over some number they picked, and that’s it. You don’t get anything.”
The Student Loan Layer Nobody Asked About
Sitting across from Theresa in a corner of that SSA waiting room, what struck me most was how the student loan debt operated as a kind of silent tax on every other decision she made. The $312 monthly payment under her income-driven repayment plan was, in isolation, manageable. But it had been calculated based on her income at a point when overtime was still part of the picture.
She had since submitted a recertification request to her loan servicer, MOHELA, asking for her payment to be recalculated based on her reduced income. That process, she told me, had been running for nearly two months with no resolution. In the meantime, she was still expected to pay the old amount.
Under the SAVE plan — the income-driven repayment option introduced in 2023 — borrowers with incomes below a certain threshold can qualify for $0 monthly payments. As of early 2026, however, the SAVE plan had been caught in ongoing legal challenges that left many borrowers in a processing limbo. According to Federal Student Aid, affected borrowers were placed in administrative forbearance, meaning interest was not accruing — but Theresa had received no clear communication about her specific status. She was paying $312 a month into a system she wasn’t sure was even processing it correctly.
What the Application Process Actually Looked Like
I asked Theresa to walk me through the Medicaid application timeline. She had started the process in early December 2025, after sitting on it for two weeks because she kept hoping the overtime situation would reverse itself. It didn’t.
The children’s coverage came through relatively smoothly — CoverKids enrollment for the four kids was confirmed by late December. That part worked. But the adult determination dragged, required extra paperwork, and ultimately delivered a denial letter that Theresa described as “exactly one paragraph, like they typed it from a template.”
She had not yet appealed. She told me she wasn’t sure an appeal would change the income math. “What am I going to argue? That I make less than I make?”
Where Things Stand Now
When I spoke with Theresa in February 2026, she and Marcus were still uninsured as adults. The kids were covered. The marketplace plan they had previously carried was gone — she had let it lapse in January when she could no longer afford the $618 monthly premium without the overtime subsidy. She was aware that a special enrollment period might be available to her given the income change, and she had bookmarked the HealthCare.gov special enrollment page but hadn’t gone back to it.
The student loan recertification was still pending with MOHELA as of our conversation. She was continuing to pay $312 per month, treating it as money she might or might not get credited properly. “I just keep paying it,” she said. “Because the alternative is defaulting, and I know enough to know that’s worse.”
A Story Without a Clean Ending
I followed up with Theresa by phone in mid-March 2026. The loan recertification had finally come through — her monthly payment was adjusted down to $194, which saved her $118 a month. She called it “a small win.” She and Marcus were still uninsured.
She was researching a lower-tier marketplace plan — a bronze-level option she estimated would run around $390 per month after a recalculated premium tax credit based on her revised income. She had not enrolled yet. The SSA documentation issue she had originally come in to resolve — a records mismatch for Marcus related to a prior address — had been corrected in late February.
What stays with me from the two conversations I had with Theresa is not any single policy failure but the texture of the exhaustion she carried. She was not bitter. She wasn’t looking for someone to blame. She understood, in a practical way, how income thresholds work and why they exist. She just found herself on the wrong side of one, through no dramatic catastrophe — just the quiet loss of a few hundred dollars a month that her entire budget had been quietly depending on.
“I’m not looking for sympathy,” she told me during our March call. “I just want to not be one emergency away from everything falling apart. That’s all I want. That feels like it should be possible.”
For a 27-year-old with a graduate degree, four kids to help raise, and a job she shows up to every morning before 6 a.m., it does not seem like an unreasonable thing to want.
Camille Joséphine Archer is Senior Benefits & Social Programs Writer at Benefit Reporter. This article is reported journalism and does not constitute financial, legal, or benefits advice.
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