Medicaid. Is it being abused? - page 17

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   grannynurse FNP student
    Quote from mstigerlily
    I had Medi-Cal on and off for a few years and I was thrilled that it covered OTC meds, I never asked but doctors wrote prescriptions where I got condoms, Tylenol, Motrin, Monistat and tons of other OTC things free. I was wondering why some of the pharmacy clerks seemed irritated by this - now I know.

    As far as some posters saying they have never seen people abusing Medi-Cal I just can't believe that. Maybe they should move to San Diego. Any illegal alien (especially a pregnant one) can get approved instantly for benefits here while us English speaking white taxpaying citizens are treated with suspicion if we ask for Medi-Cal. It took me nine months to get approved and I had to endure many, many visits to the county office, copies of paperwork brought to them - even a surprise home visit from the Medi-Cal worker where she looked in my cabinets and in my closets. That was fun. I had a second-trimester miscarriage in the ER while using temporary Medi-Cal and I"ve never been treated so badly before.
    The rules that you exist under are in force because of the California state legislature. I received Florida Medicaid and did not have to wait long for my card. I had to provide proof of my $286 a month income. Loss of my IRA, car, my condo and my bank accounts. Nor did I have to undergo a home visit by a state worker. Florida didn't require them. And when I had to use either my W/C or Medicaid coverage, I was fortunate, with one exception, I was treated like every other patient.

    Grannynurse
  2. by   mstigerlily
    Quote from mercyteapot
    I live in San Diego. Undocumented immigrants can only be approved for emergency Medi-Cal; covering pregnancy and infectious diseases. Do you really want women giving birth in the street or people with TB running around untreated?
    I'm not sure if this is directed at me or not? No, of course I don't want people giving birth in the street. That's silly - any women in labor or gravely ill person will be seen at any L&D or ED whether they are uninsured or have Medi-Cal.

    Have you applied for Medi-Cal here? I have - twice - and it was an onerous, degrading and tedious process. Once one hoop was jumped through, another appeared. I became convinced that they made it so difficult because they hoped most people would simply give up before finishing the process.

    And yet, I saw legions of Mexican families approved instantly while they lived with men they weren't married to (or listed them as "missing") their husbands worked for cash only under the table and they lived with their extended families, sometimes 8-10 people in a house. Not saying they were wealthy by any means, but did they have more than they claimed - yes. Was it easier for them to get Medi-Cal while I had to wait and jump through hoops? It seemed that way to me.

    I really don't have any beef with Mexicans at all, I don't mind if they get free healthcare - but I think we should all get free healthcare (or at least subsidized).
  3. by   grannynurse FNP student
    Quote from mercyteapot
    I live in San Diego. Undocumented immigrants can only be approved for emergency Medi-Cal; covering pregnancy and infectious diseases. Do you really want women giving birth in the street or people with TB running around untreated?

    I understand this is a common complaint and misunderstanding that runs riot in the Southwest. It ranks up there with illegals paying no taxes, when many have illegal social security numbers and never collect on their withholding, same with income tax. It ranks up there with the current second and third generation welfare reciepents, which has existed in almost ten years. I guess when people think their tax money is being ill used or stolen, they go over board on their mistakes.

    And to answer your question, as a former resident Of San Diego and a graduate of Hoover High, no, I certainly do not want a mom giving birth in the street or people running around with untreated infectious diseases. We have enough health problems without adding to them.

    Grannynurse
  4. by   mercyteapot
    Quote from mstigerlily
    I'm not sure if this is directed at me or not? No, of course I don't want people giving birth in the street. That's silly - any women in labor or gravely ill person will be seen at any L&D or ED whether they are uninsured or have Medi-Cal.

    Have you applied for Medi-Cal here? I have - twice - and it was an onerous, degrading and tedious process. Once one hoop was jumped through, another appeared. I became convinced that they made it so difficult because they hoped most people would simply give up before finishing the process.

    And yet, I saw legions of Mexican families approved instantly while they lived with men they weren't married to (or listed them as "missing") their husbands worked for cash only under the table and they lived with their extended families, sometimes 8-10 people in a house. Not saying they were wealthy by any means, but did they have more than they claimed - yes. Was it easier for them to get Medi-Cal while I had to wait and jump through hoops? It seemed that way to me.

    I really don't have any beef with Mexicans at all, I don't mind if they get free healthcare - but I think we should all get free healthcare (or at least subsidized).
    No, I haven't applied for Medi-Cal, but part of my job is helping people navigate the system of application and appeal. I'm not an attorney, but I have a fairly strong understanding of it. You say that the ER has to cover them whether they have Medi-Cal or not. Do you honestly believe that these costs aren't passed on to the taxpayer, in one form or another? It seems as if you're saying that you don't object to them getting free care, just not under Medi-Cal, as if the costs to Joe Q. Public are any lower. Interesting, if misguided, viewpoint. And I repeat, it is absolutely NOT true that undocumented immigrants can be approved for full scope Medi-Cal. I challenge you to post anything that documents that they can be.
  5. by   paphgrl
    Quote from Hellllllo Nurse
    I totally agree! My husband and I have no children, and we pay 30% of our income in taxes, and do not get tax refunds.
    There is no logical reason to reward those who add to the problem of teen and unwed pregnancy.

    If a person can support the children they create, then that is a whole other matter.

    I just hate the fact that so many get a free ride as a reward for their irresponsible actions.

    I can understand running into rough circumstances, and needing some TEMPORARY assistance, but these people who make it a way of life are beneath contempt.

    I wish that some one would invent a shot that could be given at birth, which would prevent pregnancy. The only way to become pregnant would be to take an antidote. A person would have to be at least 21 years old and finacially able to support a child in order to qualify for the antidote.

    Then, all pregnacies would be intended and wanted.
    Yeah, I agree. Income level should be a qualification for people to reproduce. And they should have to take an IQ test too. We could bar people from having kids if they are predisposed to a genetic disease, or cancer...or high colesterol. We dont want to have to pay for the medical bills for unhealthy prodgeny for others. And maybe we shouldn't allow ugly people to breed either.
  6. by   mercyteapot
    Quote from grannynurse FNP student
    I understand this is a common complaint and misunderstanding that runs riot in the Southwest. It ranks up there with illegals paying no taxes, when many have illegal social security numbers and never collect on their withholding, same with income tax. It ranks up there with the current second and third generation welfare reciepents, which has existed in almost ten years. I guess when people think their tax money is being ill used or stolen, they go over board on their mistakes.

    And to answer your question, as a former resident Of San Diego and a graduate of Hoover High, no, I certainly do not want a mom giving birth in the street or people running around with untreated infectious diseases. We have enough health problems without adding to them.

    Grannynurse
    I don't understand how these stories of lifetime welfare recipients persist. I know that for a very long time, there was a "welfare as paycheck" subculture in America. That changed with the passage of welfare reform. Of course, many of the people who are telling these stories are still using the AFDC designation, which no longer exists. It isn't called TANF- Temporary Assistance to Needy Families for nothing, my friends!
  7. by   mstigerlily
    I was just answering your question "Do I want them delivering babies int eh street?" The answer is "NO - in our country - no one has to deliver babies (or die of a life threatening condition for that matter) because our ERs and L&Ds are required to take on these patients, insured or not. I understand taxpayers bear the burden for this.

    And yes, I wish we had socialized medicine similar to Canada or Australia or most of Europe. I wish healthcare was affordable to everyone. I know there are problems with the systems there - long waits, substandard care, low pay for health care providers, high taxes. But I don't like our system here either.

    As far as your statement that illegal aliens don't get full Medi-Cal there is a good review of the problems.

    http://www.lao.ca.gov/analysis_1997/...l97.html#_1_15

    As far as emergency services the problems are noted here:

    There are several reasons why the cost of emergency Medi-Cal services is roughly comparable to the cost of full-scope services:

    * Emergency Services Are Broadly Defined. Under federal law, emergency services include labor and delivery and the treatment of any acute condition (including severe pain) that threatens to seriously jeopardize a person's health or the proper function of any organ or part of the body. Thus, this definition is broad enough to include many types of routine care.

    * Emergency Care Is Costly to Provide. Emergency care tends to be delivered in relatively costly settings, such as hospital emergency rooms. Since emergency benefits generally do not include preventive care or ongoing medication to control chronic conditions, services may be less frequent but more intensive than for full-scope beneficiaries. For example, Medi-Cal spending on hospital inpatient care for the immigrants restricted to emergency services is about 45 percent greater per eligible than for comparable eligibles receiving full-scope benefits.

    * California Provides Ongoing Access. In California, beneficiaries who are eligible only for emergency services are given a Medi-Cal card (coded for restricted benefits) that they can use whenever they need emergency services. This may encourage the use of these services in comparison to more restrictive arrangements, such as the practice in Texas, which limits each authorization for emergency services to the duration of the immediate medical problem.

    As far as Medi-Cal being restricted to pregnancy, you may have noticed that a Mexican woman of childbearing age can spend a goodly chunk of time pregnant. And Medi-Cal, once you are in the system, is merely renewed quarterly (every three months) by filling out a paper and returning it by mail. Example being, in January 2006 a Mexican woman gets Medi-Cal based on her six week pregnancy. She is due in September 2006. In September 2006, her child #1 is born (who as a citizen born on U.S. soil is entitled to full Medi-Cal benefits of course). She has already filled out her renewal by mail so is covered through Jan 2007. In January, perhaps they drop her but she can always use the option above if she is sick, using the Emergency Room as primary care. But lo and behold she becomes pregnant with child #2, thus ensuring her Medi-Cal through 2008. This cycle can go on for quite awhile as their culture traditionally has large families. And these children keep the mother in the U.S. because as U.S. citizens these children can stay permanently, their citizenship can prevent a parent's deportation, and once adults they can sponsor their parents for permanent residence.

    http://www.cis.org/articles/2005/back805.html

    Melissa


    Quote from mercyteapot
    No, I haven't applied for Medi-Cal, but part of my job is helping people navigate the system of application and appeal. I'm not an attorney, but I have a fairly strong understanding of it. You say that the ER has to cover them whether they have Medi-Cal or not. Do you honestly believe that these costs aren't passed on to the taxpayer, in one form or another? It seems as if you're saying that you don't object to them getting free care, just not under Medi-Cal, as if the costs to Joe Q. Public are any lower. Interesting, if misguided, viewpoint. And I repeat, it is absolutely NOT true that undocumented immigrants can be approved for full scope Medi-Cal. I challenge you to post anything that documents that they can be.
  8. by   mercyteapot
    Quote from mstigerlily
    I was just answering your question "Do I want them delivering babies int eh street?" The answer is "NO - in our country - no one has to deliver babies (or die of a life threatening condition for that matter) because our ERs and L&Ds are required to take on these patients, insured or not. I understand taxpayers bear the burden for this.

    And yes, I wish we had socialized medicine similar to Canada or Australia or most of Europe. I wish healthcare was affordable to everyone. I know there are problems with the systems there - long waits, substandard care, low pay for health care providers, high taxes. But I don't like our system here either.

    As far as your statement that illegal aliens don't get full Medi-Cal there is a good review of the problems.

    http://www.lao.ca.gov/analysis_1997/...l97.html#_1_15

    As far as emergency services the problems are noted here:

    There are several reasons why the cost of emergency Medi-Cal services is roughly comparable to the cost of full-scope services:

    * Emergency Services Are Broadly Defined. Under federal law, emergency services include labor and delivery and the treatment of any acute condition (including severe pain) that threatens to seriously jeopardize a person's health or the proper function of any organ or part of the body. Thus, this definition is broad enough to include many types of routine care.

    * Emergency Care Is Costly to Provide. Emergency care tends to be delivered in relatively costly settings, such as hospital emergency rooms. Since emergency benefits generally do not include preventive care or ongoing medication to control chronic conditions, services may be less frequent but more intensive than for full-scope beneficiaries. For example, Medi-Cal spending on hospital inpatient care for the immigrants restricted to emergency services is about 45 percent greater per eligible than for comparable eligibles receiving full-scope benefits.

    * California Provides Ongoing Access. In California, beneficiaries who are eligible only for emergency services are given a Medi-Cal card (coded for restricted benefits) that they can use whenever they need emergency services. This may encourage the use of these services in comparison to more restrictive arrangements, such as the practice in Texas, which limits each authorization for emergency services to the duration of the immediate medical problem.

    As far as Medi-Cal being restricted to pregnancy, you may have noticed that a Mexican woman of childbearing age can spend a goodly chunk of time pregnant. And Medi-Cal, once you are in the system, is merely renewed quarterly (every three months) by filling out a paper and returning it by mail. Example being, in January 2006 a Mexican woman gets Medi-Cal based on her six week pregnancy. She is due in September 2006. In September 2006, her child #1 is born (who as a citizen born on U.S. soil is entitled to full Medi-Cal benefits of course). She has already filled out her renewal by mail so is covered through Jan 2007. In January, perhaps they drop her but she can always use the option above if she is sick, using the Emergency Room as primary care. But lo and behold she becomes pregnant with child #2, thus ensuring her Medi-Cal through 2008. This cycle can go on for quite awhile as their culture traditionally has large families. And these children keep the mother in the U.S. because as U.S. citizens these children can stay permanently, their citizenship can prevent a parent's deportation, and once adults they can sponsor their parents for permanent residence.

    http://www.cis.org/articles/2005/back805.html

    Melissa
    A) The question about people giving birth in the streets was rhetorical. I didn't actually believe anyone would answer me, but at least you both said no.

    B) None of what you've posted speaks to the claim that undocumented aliens can get full scope Medi-Cal. However, it does all speak to the systemic issues within Medi-Cal. The problem isn't abuse of the rules, it's the rules themselves. The end.
    Last edit by mercyteapot on Jan 8, '06
  9. by   grannynurse FNP student
    Quote from mercyteapot
    I don't understand how these stories of lifetime welfare recipients persist. I know that for a very long time, there was a "welfare as paycheck" subculture in America. That changed with the passage of welfare reform. Of course, many of the people who are telling these stories are still using the AFDC designation, which no longer exists. It isn't called TANF- Temporary Assistance to Needy Families for nothing, my friends!
    Like I said Mercy, when people think their tax dollars are being misused, they tend to lose their logical thinking ability. I've got an aunt and uncle, well educated, who continue to complain about lifetime welfare recipients. I've given up trying to reeducate them.

    Grannynurse
  10. by   grannynurse FNP student
    Quote from mercyteapot
    A) The question about people giving birth in the streets was rhetorical. I didn't actually believe anyone would answer me, but at least you both said no.

    B) None of what you've posted speaks to the claim that undocumented aliens can get full scope Medi-Cal. However, it does all speak to the systemic issues within Medi-Cal. The problem isn't abuse of the rules, it's the rules themselves. The end.

    Hey, isn't that what I have maintained. Each state sets what they will cover and what they will not. What is covered in California or New York, is not covered in Florida. What medications and the number of them, covered in California and New York, is severely restricted in Florida. If people are upset with what their state covers, take it up with your state legislature. Just remember, you or someone you care about may some day need Medicaid. Do you want their coverage restricted to save a few tax dollars.

    Grannynurse
  11. by   irishnurse67
    Quote from multicollinarity
    This is an example of lack of bounderies. First demonstrated by rebuffing the request for nicotine patches. (Free for you! Not for me! Cheaper than your cigs!) Then, a lack of boundaries with providing rides to patients. One is for ill, the other well-meaning. The take home lesson is a reminder in boundaries. We don't get to deny treatment because of our political beliefs, and we don't get to provide rides to patients who tug on our heart-strings.

    What we are supposed to do is provide medical care within the scope of RN practice.
    I
    Last edit by irishnurse67 on Mar 27, '06
  12. by   mstigerlily
    Quote from mercyteapot
    B) None of what you've posted speaks to the claim that undocumented aliens can get full scope Medi-Cal. However, it does all speak to the systemic issues within Medi-Cal. The problem isn't abuse of the rules, it's the rules themselves. The end.
    Uh..ok. My point was that there isn't much difference between "Full scope Medi-Cal" and the Medi-Cal offered to illegal aliens.

    Thus:

    a) If Medi-Cal only covers you when you are pregnant and you are pregnant most of the time (and there is no restriction on this), then that is "full scope"

    AND

    b) If Medi-Cal only covers you when you have an "emergency" (and there is no restriction on this) but nearly *everything* counts as an emergency and you use the ER as a doctor's office, then that is "full scope"
    Last edit by mstigerlily on Jan 8, '06
  13. by   grannynurse FNP student
    Quote from mstigerlily
    Uh..ok. My point was that there isn't much difference between "Full scope Medi-Cal" and the Medi-Cal offered to illegal aliens.

    Thus:

    a) If Medi-Cal only covers you when you are pregnant and you are pregnant most of the time (and there is no restriction on this), then that is "full scope"

    AND

    b) If Medi-Cal only covers you when you have an "emergency" (and there is no restriction on this) but nearly *everything* counts as an emergency and you use the ER as a doctor's office, then that is "full scope"
    So what do you suggest be done? I have an idea. Pregnant and go into labor, illegal, ship their a** back across the border before they can give birth. And make sure you hold their legs together to impede their ability to deliver until you drop them off on their side of the border. In this manner, you save tax dollars and make one less citicizen to grab your California, Arizona, New Mexico, Texas tax money and clog up your ERs, school systems, etc, etc. And if you have a baby in this country and you are illegal, we will tie your tubes, solving two problems--you can't have any more kids and you can't use up our tax dollars, by coming back here to deliver.

    Now this idea sounds like a bit much, doesn't it? I sure hope so. Emergency rooms could help solve part of the problem by operating twenty-four hour Urgent Care units, couldn't they? It would certainly cut down on the abuse of ER visits. And these units could be staffed by NPs and PAs with one physician, cutting down the cost even further. And Medicaid could reduce the payment, since a full service ER would no longer be used. And I'm sure health insurance companies and over worked PCP would love to refer to them as well, especially on off hours.

    This is one idea but it will never float. The people with health insurance will never go for it, lessing of their benefits. And some patients, such as myself will object because by the time we arrive we really do need emergency care, not urgent care. And those funding Medicaid through their tax dollars will view it as another give away program and more waste of their tax dollars.

    All right people, I am open for any fresh, new ideas, that save money and treat patients, regardless of whose is paying and their legal status. ANYONE?????????????????????????????

    Grannynurse

close