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Shake down

Tremors have become a way of life for Marcelino Cruz. The 65-year-old legal immigrant from the Dominican Republic gently shakes - his right hand and right leg especially - as he sits in his favorite, well-worn chair. He shakes as he shuffles around his modest one-bedroom apartment. He shakes as he opens the four medicine bottles prescribed to combat the symptoms associated with Parkinson's disease. The tremors have become so persistent and intense that Cruz cannot even clasp his own hands.

"I feel real bad," Cruz says, speaking in Spanish through a translator. He is a small, slight man who exudes an air of quiet sadness. "I cannot do anything. When I do, I have to wait until the medication takes effect."

This is not the kind of existence Cruz had anticipated. When he arrived in this country in May 1999, he had big dreams. He imagined himself working as a salesman, as he'd done in Santo Domingo for decades. He imagined himself pitching in to support five of his adult children (he has eight in total) and his 12 grandchildren - all of whom reside in Lawrence. He imagined thriving in America. His dreams, however, were never realized. For almost as soon as he'd settled in Massachusetts, the symptoms of Parkinson's disease - the involuntary tremors, the headaches, the fatigue - surfaced. By 2000, his condition had deteriorated enough to require monthly visits to a neurologist, as well as four prescription drugs. With no work and thus no health insurance to speak of, Cruz applied for Medicaid benefits.

For the longest time, he experienced little anxiety over his medical condition. As a full-coverage Medicaid recipient, all his check-ups, neurological exams, and prescriptions were covered. Until August, that is, when he went to see his doctor at the Greater Lawrence Family Health Center, and the receptionist told him that his Medicaid card wasn't working. (Cruz says he never received a letter from the Division of Medical Assistance, or DMA, explaining he'd lost his health-care benefits in July, when the state agency that administers Medicaid distributed some 10,000 letters to legal immigrants about the FY '04 budget cut.)

Cruz's first concern was his medications - and what his tremors would feel like without them. Then, he thought about money: the drugs cost $250 per month. Yet his welfare benefits total only $303, which he uses to pay for rent, utilities, food, and medical co-payments. Obviously, there'd be no way for him to afford the full price of the medicines. And without his pills, he says, "I would go crazy from shaking. It'd be very, very difficult."

Cruz decided that he couldn't risk going a month without his medicine. So he turned to his doctor's Medicaid advocate, Delis Pizarro, who suggested that he seek help through the state's Emergency Assistance for Elderly, Disabled, and Children (EAEDC) program, which is administered by the welfare department. On October 7, he received a letter from the DMA explaining that, as an EAEDC recipient, he was eligible for limited Medicaid to cover his prescriptions - at least, temporarily. To date, Cruz hasn't had to pay for his drugs. But the uncertainty of his health insurance unnerves him: whenever he walks into a pharmacy, he fears that his card will be denied.

That state officials would willfully thrust this type of anxiety onto an entire population of Massachusetts residents disturbs Cruz. It wasn't so long ago that he had been able to receive food stamps. Last fiscal year, however, after a similar budget-crunching move, Massachusetts stopped issuing such benefits to poor legal immigrants. Now, officials are doing the same with another vital necessity - health care.

It's a reality that Cruz finds ironic. "Politicians," he explains, "always talk about immigrants when they campaign, but they forget about us the rest of the time." As far as he's concerned, he adds, "Politicians need to say less and do more."

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