A coverage gap Catch-22: To work, Selinda Walker needs health care. To get health care, she needs work.

Forty-seven-year-old Selinda Walker had to move back in with her elderly mother after an untreated and severe case of Graves’ disease left her unable to work and live independently.

As a single, low-income individual with no children, Walker has no path toward health care in the state of Mississippi, which remains one of 10 states in the country not to expand Medicaid. And as lawmakers advocate for work requirements in Medicaid expansion bills, Walker faces a Catch-22: she needs health insurance first to get healthy enough to be able to return to work.

The progression of her disease made it impossible for her to continue working at her jobs in retail and car sales. The worst of her symptoms cause her to suffer dizzy spells and temporarily-paralyzing falls throughout the day, among a slew of other problems.

“I feel like I’m a burden to my mother,” Walker, who lives in Columbus, said. “She has to do so much because I can do so little. There are days where I am just useless, the pain is so bad.”

Since she inherited the gene from both her parents, Walker has a textbook case of the autoimmune disease with all of its worst symptoms. The condition, which causes the immune system to mistakenly attack healthy tissue, gets progressively worse if left untreated.

Without health insurance, Walker’s only recourse is a free clinic in Tupelo, about an hour and a half away from where she lives in Columbus. The clinic is able to prescribe her thyroid medications to varying degrees of success, but it’s nothing compared to the quality of life improvement she might experience if she were able to get the proper tests done and potentially undergo a more permanent solution like thyroid surgery.

One of the 10 medications she’s currently on helps treat the insomnia associated with Graves’ disease, but it sometimes causes her to sleep through the day. None of the medications help alleviate her back pain or the gut issues, chills or tremors she lives with.

“It’s very scary to think I don’t have anybody to check me out every month … every day I’m wondering if I’ll wake up,” she mused.

As a childless adult, Walker doesn’t qualify for Medicaid – period. She says the last two times she applied for disability Medicaid, case workers told her they could only help her if she got pregnant.

“I was shocked,” Walker said. “I couldn’t believe what I was hearing. Mississippi is one of the strangest states ever. The only way to help me is if I have children?”

Even if she had children, or if that rule didn’t exist, Walker was at that time making more than 28% of the federal poverty level, a mere $7,000 annually for a family of three – the maximum salary a Mississippi family can make and still qualify for Medicaid – working full-time at her jobs in retail and car sales.

And she’s far from the only one. Anyone making at least minimum wage working full-time makes more than 28% of the federal poverty level, which then counts against them and disqualifies them from Medicaid.

Walker is one of tens of thousands of Mississippians who fall into the “coverage gap.” These individuals don’t qualify for Medicaid under the state’s current restrictions but make less than the 100% of the federal poverty level, about $15,000 a year for an individual, that would qualify them for subsidies that make marketplace insurance affordable.

The coverage gap exists in states that have not expanded Medicaid under the Affordable Care Act, which presumed all states would automatically expand Medicaid. However, a 2012 Supreme Court ruling made expansion optional for states.

New proposals in the Mississippi Legislature would expand Medicaid, as 40 other states have done, covering families and adults with a household income of up to 138% of the federal poverty level, under the House plan, or 99%, under the Senate plan.