The conventional wisdom about Medicaid goes something like this: if you are poor and need healthcare, the government will cover you. That assumption, tidy as it sounds, does not survive contact with reality — particularly not for people like Pearl Kowalski, who are poor by any practical measure yet still find themselves turned away at the door, sometimes more than once.
I first encountered Pearl in February 2026 at the Ernie Pyle Branch Library in Albuquerque, New Mexico, where the New Mexico Human Services Department was hosting a Medicare and Medicaid enrollment event. I was covering the event for Benefit Reporter, notebook in hand, watching a long line of older residents shuffle toward enrollment counselors. Pearl stood near the back of the room, clearly younger than almost everyone else there, holding a manila folder thick with papers and looking like she had not slept in several days. She approached me first, asking if I was with the government. When I told her I was a journalist, she said, almost to herself, “Good. Someone should hear this.”
A Life Built Around Everyone Else
Pearl Kowalski is 26 years old, a licensed journeyman plumber working for a mid-sized contractor in Bernalillo County. At the time she first applied for Medicaid in April 2025, she was bringing home approximately $24,000 a year after taxes — a figure that had dropped from closer to $31,000 the prior year because she had cut back her hours to care for her mother, Renata, who was 67 and managing a combination of Type 2 diabetes and early-stage kidney disease.
Pearl is also a single mother. Her son, Marcus, was four years old at the time of our conversation. The boy’s father had not paid child support in over a year — a gap that Pearl said cost her roughly $400 a month she had been counting on. Her credit score, damaged by a period of medical debt and a defaulted credit card from when she was 22, sat in the low 500s. Between the unpaid support, reduced work hours, and the cost of her mother’s prescriptions, Pearl’s monthly budget had no margin at all.
“I kept thinking, I do everything right,” Pearl told me, sitting across from me at a library table after the event had wound down. “I showed up to work, I took care of my mom, I filed my taxes. And they kept telling me something was wrong with my paperwork.”
The First Denial — and the One No One Explained
Pearl submitted her first Medicaid application through the YesNM portal in April 2025. The online system, which New Mexico uses to process Centennial Care applications, asked for income documentation, household composition, and proof of residency. Pearl gathered her W-2 from 2024, a letter from her employer confirming her reduced hours, and utility bills showing her Albuquerque address.
Six weeks later, a denial letter arrived. The stated reason: her household income could not be verified because of a discrepancy between her reported 2024 wages ($31,200) and her projected 2025 income ($24,000). The system, Pearl said, appeared to be averaging the two figures rather than accepting her reduced-hours letter as evidence of the income change.
Pearl said she called the HSD helpline three times over the following two weeks trying to understand the denial. Each call, she told me, lasted between 40 minutes and an hour, and each time she was given a slightly different explanation. “One person told me I needed a new letter. Another said the letter was fine but I hadn’t included something about my mom living with me. I stopped writing things down because the answers kept changing.”
She reapplied in June 2025, this time including a notarized statement about her household composition, a second letter from her employer, and three months of bank statements. That application was denied in August 2025. The reason cited this time: her mother had not been listed correctly as a dependent member of the household, which affected the household size used to calculate the income threshold.
The Turning Point — A Counselor at a Library Event
By the time Pearl walked into that February 2026 library event, she had been uninsured for nearly eight months. Her mother had been enrolled in Medicare Part A and B since turning 65, which covered hospitalizations and outpatient visits — but not, Pearl noted, the full cost of Renata’s insulin and blood pressure medications, which ran approximately $340 a month out of pocket. Pearl had been covering that cost herself, sometimes by skipping her own prescriptions for a mild thyroid condition.
At the event, a certified enrollment counselor named Dora — a volunteer with a local nonprofit — sat with Pearl for nearly 45 minutes. Dora identified the core problem immediately: Pearl’s mother, because she had her own Social Security income of about $890 a month, had been incorrectly flagged in the applications. Renata needed to apply for Medicaid separately, as a low-income Medicare beneficiary potentially qualifying for a Medicare Savings Program, while Pearl’s application needed to reflect only herself and Marcus as household members.
This distinction — between a financial caregiver and a Medicaid household member — is one the system does not communicate clearly in its online portal or denial letters. As Pearl described it, the letters never told her what to fix, only that something was wrong.
How the Third Application Was Different
With Dora’s guidance, Pearl submitted a corrected third application in late February 2026. This one listed only Pearl and Marcus, with projected annual income of $24,000 for a household of two — well below the 138% FPL threshold of approximately $28,200 for that household size. Renata’s application for a Medicare Savings Program was submitted separately.
Pearl received an approval notice on March 18, 2026 — three weeks after submission. Coverage was effective retroactively to March 1. Her mother’s Medicare Savings Program application was still pending at the time of our conversation, but Dora had told Pearl to expect a decision within 45 days.
The Outcome, and What Pearl Carries With Her
Pearl Kowalski now has Medicaid coverage under New Mexico’s Centennial Care program. She filled her thyroid prescription the week her card arrived — the first time she had done so in four months. Marcus also qualified for coverage through the Children’s Medical Insurance Program (CHIP), which she had not known to apply for separately during her earlier attempts.
The relief was real, but Pearl’s tone when she described it was not celebratory. She was frustrated, quietly and firmly, about how long it had taken and what it had cost her in the interim — including one urgent care visit in November 2025 that ran her $380 out of pocket for a respiratory infection she had tried to wait out.
She was also still navigating the child support situation when we spoke. With no legal enforcement action yet filed, the missing $400 a month from Marcus’s father remained an unresolved gap. Pearl said she had contacted the New Mexico Child Support Enforcement Division but had not yet heard back with a hearing date.
According to Medicaid.gov, roughly 84 million Americans were enrolled in Medicaid or CHIP as of late 2025 — a record high. Yet the application error rates and denial rates for working adults with variable incomes remain stubbornly elevated, particularly in states where online portals have not been updated to handle income fluctuations or caregiving situations clearly.
Pearl said she plans to eventually go back for her master plumber’s license, which would raise her earning ceiling considerably. For now, she is focused on getting through each week — work, her mother’s medication pickups, Marcus’s preschool schedule — and hoping her mother’s Medicare Savings Program application comes through before summer.
When I packed up my recorder and shook Pearl’s hand outside the library, she was headed straight to pick up Marcus from her neighbor’s apartment. She had a full shift the next morning starting at 6 a.m. She did not seem like someone who expected things to be easy. She just expected them to work the way they were supposed to.
That expectation, it turned out, was the most expensive thing she owned.
Related: He Paid $374 a Month for Health Insurance on $34,000 a Year — Then One Phone Call Changed Everything
Related: A 30% Rent Hike Nearly Broke This St. Louis Family — What Changed When They Finally Asked for Help
Leave a Reply