Medicaid. Is it being abused? - page 21

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 LeahJet
    When I am working in the ER/triage, I have no idea what the person drives up in, it could be a clunker or a Bentley. I have no idea what their home looks like. They could be carrying a Louis Vuitton, but these days, 95% are knock-offs. They could be covered in ice, but CZ is sold everywhere. My point is, I have not the time OR desire to make personal judgements. It is none of my business.

    I do, however, make nursing judgements when I triage. And I know there is an astounding amount of Medicaid that come to the ER for obvious clinic type issues. In my 10 years of ER nursing, when I tried to educate, was met with everything from nonchalance to hostility. I will interject that I am a very tactful and diplomatic person. Therefore, I believe the majority of the problem is not as much misinformation as it is a sense of entitlement. People can not be bothered with silly things such as making an appointment and maybe having to wait a couple of days for a semi/chronic condition.

    Do I think that Medicaid patients are the only ones that abuse the ER/health care system? No. But that is what the topic is about.

    In the long run, poor saps that work and pay for insurance are the ones that put off seeking care due to astronomical deductables.

    I spent almost twenty-five years of my professional life attempting to impart some health care wisdom on many of my patients. There were those that listened and learned. And there were those that did not. And they ended up back in my ER, or on my unit, or as my home health care patient, again. Where I once more attempted to teach them the appropriate things necessary for improving their health. And again and again I had to reteach them. Eventually most learned but not before suffering complications but what am I to do? Throw my hands up and not attempt to continue to educate them? For me, the answer is no.

    I have a problem I would like your input on. I have a sixty year old patient, who among other things, suffers from hypertension, insulin dependent diabetes, a seizure disorder and asthma. At one time, her asthma was triggered by cat dander. Her pulmonologist put her on Singulair and it appears to control her asthma. However, she still has some attacks, that require hospitalizations. She lives with her grown daughter, who has several cats. Her pulonomolgist has told her to either move out or have her daughter get rid of the cats, neither of which can happen for a number of reasons. Now, what should I advise her to do? What should I attempt to teach her about limiting her exposure to the family cats? Should I advise her to move out on her limited income? I would really appreciate anyone's input and suggestions on how to handle this patient. She apparently has several choices but refuses to make them. What do you suggest?

    Grannynurse
  2. by   grannynurse FNP student
    Quote from wildcats
    Kind of OT, but I was wandering if you could tell me what foods aren't supposed to be bought with food stamps? I worked in a grocery store and the people with foodstamps have been able to purchase sodas, candy, and anything else they want as long as it can be eaten. The only thing I have seen that they cannot purchase is fresh made foods from grocery store salad bars or the deli. Thanks.

    Candies, sodas, beer, wine, and any prepared foods. Also any paper, plastic or other non food items. If one is purchasing soda and candy, you are breaking the law. Suggest you go to your state's food stamp website. They have a list of what cannot be purchased. I have complained to a store manager when I saw someone buying candy with food stamps. The cashier was instructed not to allow it again.

    Hope this clears the matter up for you.

    Grannynurse
  3. by   mercyteapot
    I don't know what food can't be bought with food stamps here, but recipient's now get a card that looks just like a debit card with which to pay. No one in line would know what was going on. It made me think, though, of the last time I was in the ER. I had been doing dishes and a casserole dish broke and a piece ricocheted into my knee. Other than the fact that the triage nurse was incredulous that I was presenting with such a minor looking wound (which in reality took 20 stitches to close), I distinctly remember being sent to an entirely different area to give my financial information. I'm not sure those doctors or nurses would have had a clue who was paying for their handiwork or how. Knowing the reputation of the HMO we had at the time, they probably ended up being reimbursed even less than they would have been through Medi-Cal, but other than the triage nurse, they all treated me with the same respect they were according all other patients.
    Last edit by mercyteapot on Jan 9, '06
  4. by   LeahJet
    Quote from mercyteapot
    I'm not sure those doctors or nurses would have had a clue who was paying for their handiwork or how.
    "face sheets"
  5. by   LeahJet
    Quote from grannynurse FNP student
    She apparently has several choices but refuses to make them. What do you suggest?Grannynurse
    The old analogy "You can lead a horse to water......" comes to mind.

    And I couldn't imagine why the daughter "can't" get rid of the cats. I mean, I am an animal lover myself but come on.... when you choose some cats over your mom's airway/health...........:uhoh21:
    I think there are some underlying family dynamics here and as much as we want to help people, they have to WANT to help themselves.

    Personally, I think Social Services/counseling could come into play.
  6. by   mstigerlily
    Gosh why did you edit the post? Thankfully I got your original one in my email.

    Quote from mercyteapot
    Will you please read back over the posts? You keep making my point for me. (Thank you, by the way!) This is exactly what I'm saying. If emergency Medi-Cal is costing the govt just as much as full scope
    Medi-Cal, then the system is broken. I don't think I've ever done this before,
    because I find it kind of juvenile when people feel the need to
    announce that they're leaving a thread, but I just can't talk to you anymore.
    Sorry.
    OK I read through your posts and maybe I'm missing it, but this is the first I've heard from you that your point was "the system is broken". You kept saying your point was that illegal aliens don't get "full scope Medi-Cal" and that I needed to link to anywhere that said they did. I did link to an article which said that what they get is nearly the SAME AS full Medi-Cal.

    If your point was merely "the system is broken", well we could have agreed about 20 posts ago.

    I'm surprised I would make you consider leaving a thread, I thought our conversation rather benign. Sorry to have upset you so badly, that was not my intent.
    Last edit by mstigerlily on Jan 9, '06
  7. by   mstigerlily
    My contention was NOT that the U.S. is "the only country" that grants automatic citizenship. My statement was that "The first thing that needs to stop is if you have a baby here, that baby is automatically a citizen. You don't see people flying to France or England or Tahiti to have babies because **MOST** COUNTRIES don't have this particular law".

    I don't have time to look up the citizen laws of each country but I did find an excellent article addressing this here:

    http://www.rense.com/general54/anchorbabiesborn.htm

    Also: http://www.americanpatrol.com/ANCHOR...AllanWall.html

    which stated Ireland, Britain, Australia and Switzerland (just four examples) do not give citizenship to just anyone who is born there. So I think your statement is incorrect

    Quote from grannynurse FNP student
    Actually, ANY CHILD BORN IN A FOREIGN COUNTRY is a citizen of that country.
    As far as the California legislature, well I am taking it up with them. I do actively campaign and vote about issues dear to me and this is one of them. I am also discussing it here - but I didn't know these things were mutually exclusive.

    Other links of interest:

    http://members.lycos.co.uk/lamigra/N...40220SDUT.html
    http://www.americanpatrol.com/REFERE...baby_FAIR.html
    http://www.worldnetdaily.com/news/ar...TICLE_ID=43275
    Last edit by mstigerlily on Jan 9, '06
  8. by   wildcats
    Quote from grannynurse FNP student
    Candies, sodas, beer, wine, and any prepared foods. Also any paper, plastic or other non food items. If one is purchasing soda and candy, you are breaking the law. Suggest you go to your state's food stamp website. They have a list of what cannot be purchased. I have complained to a store manager when I saw someone buying candy with food stamps. The cashier was instructed not to allow it again.

    Hope this clears the matter up for you.

    Grannynurse
    Thanks for your response. The store I worked at never told us anything except that items that couldn't be purchased with food stamps would ring up on a separate balance when you hit the food stamp button on the register and thats exactly how it was. Non-food items, prepared foods, and beer, cigs, etc. would ring up as a separate total but the sodas and candy never did so I didn't know any better.

    As someone else mentioned in my area food stamps are now on a card called an EBT card. Don't know if its like that everywhere.
  9. by   mstigerlily
    Quote from LeahJet
    "face sheets"
    YES - face sheets. Believe me, everyone knows. I work in a ritzy area of town at a hospital where only one OB takes Medi-Cal. Just seeing his name is a sign that person is a Medi-Cal recipient. In the last few months I've had two women from Mexico City come to deliver their babies (who were both lovely people and did indeed pay their bill in cash when discharged) and one of the things I heard in report is "cash pay". Why? Because that means they want to go home early and d/c paperwork, PKU, birth certificates, hearing test, vaccines all must be done before 24 hrs is up so this is something that gets passed on from shift to shift. Same thing with Medi-Cal recipients as if they want to extend their stay sometimes it isn't covered or they need treatments that aren't covered, etc.
    Last edit by mstigerlily on Jan 9, '06
  10. by   mercyteapot
    Quote from mstigerlily
    Gosh why did you edit the post? Thankfully I got your original one in my email.



    OK I read through your posts and maybe I'm missing it, but this is the first I've heard from you that your point was "the system is broken". You kept saying your point was that illegal aliens don't get "full scope Medi-Cal" and that I needed to link to anywhere that said they did. I did link to an article which said that what they get is nearly the SAME AS full Medi-Cal.

    If your point was merely "the system is broken", well we could have agreed about 20 posts ago.

    I'm surprised I would make you consider leaving a thread, I thought our conversation rather benign. Sorry to have upset you so badly, that was not my intent.
    I wasn't considering leaving the thread, just this particular conversation. It was just clear that I wasn't getting my point across, and I was tired. I'll try one last time; if emergency Medi-Cal is costing us as much as full scope, why the **** can't we just provide full scope for anyone who needs it, so that they don't have to do things like present at the ER to get an ear infection treated? Emergency Medi-Cal is NOT the same as full scope Medi-Cal. Even if a woman spends all her time pregnant, she still won't qualify for coverage for conditions that aren't impacted by pregnancy. Neither will the rest of her family. Costing the same and being the same aren't...well, the same.
    Last edit by mercyteapot on Jan 10, '06
  11. by   grannynurse FNP student
    Quote from wildcats
    Thanks for your response. The store I worked at never told us anything except that items that couldn't be purchased with food stamps would ring up on a separate balance when you hit the food stamp button on the register and thats exactly how it was. Non-food items, prepared foods, and beer, cigs, etc. would ring up as a separate total but the sodas and candy never did so I didn't know any better.

    As someone else mentioned in my area food stamps are now on a card called an EBT card. Don't know if its like that everywhere.

    There are several websites that provide information regarding who is eligible for food stamps and how their income is counted, as well as their monthly bills and how they are factured into eligibility. It is a rather lengthy application that is quite detailed. This past fall, my daughter filled one out. She had not been able to work for more then ten weeks and had not received her long term disability. And her employer would not offer her a light duty position until she informed him she need a letter for her application. Despite my income, from SSDI and my SIL's, we still qualified, given there were six people in our household. My daughter did not want to apply but she had no choice. She would not have bought the top cuts of meat but she would not have bought the cheapest either. Pound foolish and a penny wose.

    Grannynurse
  12. by   grannynurse FNP student
    Quote from LeahJet
    The old analogy "You can lead a horse to water......" comes to mind.

    And I couldn't imagine why the daughter "can't" get rid of the cats. I mean, I am an animal lover myself but come on.... when you choose some cats over your mom's airway/health...........:uhoh21:
    I think there are some underlying family dynamics here and as much as we want to help people, they have to WANT to help themselves.

    Personally, I think Social Services/counseling could come into play.
    I'll let you in on a little secret, I am the mother, the patient. My daughter has had two of her cats more then twelve years and one more then eight. I have lived with her for two years. I have not asked my daughter to get rid of her cats. She does everything possible to keep their dander down and them restricted to her or my grandchildren bedroom. I have become acclimated to their dander and they no longer trigger a full blown asthma attack My current attacks appear to be triggered by the flucations in temperature, from 76 degrees to 40 degrees back up to 78 degrees. And after my SIL build my new room, they will be unable to get into my bedroom. That and my singulair should help solve that part of my asthma problem. Now if I could just do something about the temperature changes and the mold that triggers them.

    Thanks for taking the time.

    Grannynurse
  13. by   LeahJet
    Quote from grannynurse FNP student
    I'll let you in on a little secret, I am the mother, the patient. Grannynurse
    May I respectfully say that I fail to see the need to deceive in order to make a point? You stated "I have a patient"..... and then set up a scenario that seemed like a simple case of non compliance.
    I understand the point you are trying to make.... and there is such a word as "exacerbation" that we put in front of chronic conditions that are indeed a true emergency.

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