KISSIMMEE, FLORIDA — Derion Blackman collapsed in front of a Dollar General in Kissimmee, Florida, in March 2024. Blackman had undergone a heart transplant two years prior to his death.

His wife, Sonja Smith, switched his primary health coverage to CHAMPVA in January 2023. This change followed an increase in the monthly premium for their Federal Employees Health Benefits plan to $307. CHAMPVA, a health benefits program for dependents of disabled veterans, became Blackman's active health plan in January 2024. The CHAMPVA plan had no premium and a $3,000 deductible. Smith was declared permanently disabled due to physical and mental injuries sustained during her service on an Air Force base.

Smith described the circumstances of her husband's death, stating, "He was on a nasty, dirty ground in front of a store." She added, "He didn't deserve to die like that." Smith said she expressed her frustrations with multiple entities involved in the healthcare system, including CHAMPVA and the administration, and stated that "Everybody played a part in what happened to my husband." One of Blackman's medications cost approximately $800 a month. Blackman and Smith had called CHAMPVA in November 2023.

Adrianna McIntyre, an assistant professor of health policy at the Harvard T.H. Chan School of Public Health, commented on the US healthcare framework. She stated, "We've basically set up a series of cracks in our healthcare system that we ask people to jump over." McIntyre added, "But if you don't jump over those cracks, you can lose coverage, or lose access to your doctor, or lose access to your medications."

Federal regulations, along with 43 states and Washington, D.C., include continuity of care protections mandating health plans to continue covering doctors and drugs during network changes. However, CHAMPVA has no networks or third-party appeals process. Sabrina Corlette, a research professor in health policy at Georgetown University, explained that "When you switch to a new insurance company, they're going to apply their rules." Many insurers voluntarily agreed to reduce some administrative burdens by honoring existing prior authorizations for 90 days when a patient switches health plans.

Why It Matters

Derion Blackman's death in March 2024 occurred after a transition in his health insurance coverage, from a Federal Employees Health Benefits plan to CHAMPVA, a program for dependents of disabled veterans. The premium for his previous plan had increased, leading to the switch to a no-premium CHAMPVA plan with a $3,000 deductible. Health plan changes and the complexities of healthcare systems can affect individuals with medical needs, such as Blackman, who had a heart transplant two years prior and required costly monthly medication.

The case illustrates issues within the broader healthcare system regarding continuity of care during insurance transitions. While federal regulations and state laws in most of the U.S. include provisions for continuity of care, the CHAMPVA program, which serves approximately 1 million enrollees, does not have networks or a third-party appeals process. Experts in health policy have commented on the burdens placed on patients navigating these systems, where a failure to manage transitions can result in loss of access to medical care and medications.