Ryan Jolly: The Center of the Medicaid Venn Diagram

Ryan Jolly, a proud resident of the state of Kansas, describes herself as being at the center of many of the groups Medicaid serves. She is a daughter, a mother, a foster parent, a health care provider and a small business owner. “If the different constituencies that are affected by Medicaid were presented in a Venn diagram,” she said, “I’m that big circle in the middle where they all overlap.

As a caregiver to her elderly mother, Ryan describes how her family will depend on Medicaid when they can no longer manage in-home care. “We don’t know as a family what we will do to cover the $75,000 cost of a nursing home in our state without Medicaid,” she said. Her mother worked her entire life, saved carefully, and supported her family. Medicaid remains the only way to ensure she can age with dignity.

Ryan has served as a foster parent for 15 years, specializing in medically complex children. “In our state, there are roughly 5,000 children in foster care that rely on Medicaid for their health insurance,” she explained. Thousands more adopted from foster care also rely on Medicaid for their medical needs. She warns that cuts will put these children at risk. “I don’t know how many families will be able to open their doors to children that are abused and neglected if those families are expected to carry the financial burden of their medical care,” she said.

Two of Ryan’s children use the Technology Assistance Waiver, or TA Waiver, a part of Medicaid in Kansas for children who need hospital-level care at home. “So these are kids that without this waiver would be living their lives in an institution,” she said. “We don’t have pediatric nursing homes. Home or hospital bed are the only two choices for these children.” Without the waiver, families like hers would have no choice but to hospitalize children who could otherwise live at home with nursing support.

She highlights the fragility of these community-based services. “Homebound community-based services are a non-mandatory feature of Medicaid, so states don’t have to provide them,” she said. “Any cuts to funding… the optional things are going to go first. And in this case, those optional things are my children.”

One of her children was born with a condition that requires constant care; another developed a similar need at 16 months. “It could be anybody’s child that needs this level of care in their home,” she said, emphasizing that Medicaid remains the only resource that provides these services in the home.

Ryan also runs a small business: a private psychiatric and mental health care practice. She employs staff, contracts with vendors, and leases office space while serving a population that largely cannot access care elsewhere. “We accept Medicaid patients, and without us, with cuts to Medicaid that required us to no longer provide those services, there are no other alternatives,” she said. “Or if there are other alternatives, those waiting lists are six, nine, 12 months… if they’re lucky.”

Medicaid cuts not only threaten her ability to serve her patients but also endanger the future of her business. “If the homebound community-based services are cut for my two children… I will have to close my business to stay home to care for my children because there are no other options for those children,” she said.

As she tells her story, Ryan underscores the broader impact of Medicaid cuts. “From a business perspective, from a health care provider perspective… if [a facility] loses 40% of its funding, it cannot survive.” Families who don’t currently rely on Medicaid may still lose access to the services they expect.

Although Ryan acknowledges flaws in the system, she calls on lawmakers to understand that its functioning relies heavily on unpaid caregivers. “We are at a breaking point now. If you make that harder for us, the system will completely implode,” she said.

Her final appeal resonates on both personal and collective levels. “If you don’t care about my family, you should care about yours. Someone in your life will be drastically, negatively, potentially fatally affected by these cuts.”