Medicaid. Is it being abused? - page 22

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   grammyr
    Here's a scenario:

    Father is a pharmacist, mother is a nurse and healthy boy is on Medicaid.

    Is that abuse???:angryfire
  2. by   LoriAlabamaRN
    I don't disagree that there are people out there who legitimately need welfare. It's the people that simply refuse to get a job and then turn around with their hand out that get to me. It's not that there aren't jobs available. Any fast food place will tell you that. It's just horribly unfair that some people work in horrible conditions for minimum wage when others make far more than that by living off the state.

    I live a few miles from a public housing complex that I pass by every night on my way into work. The parking area is full of cars, and I would say that mroe than half of those cars are newer than what I can afford to drive. I see groups of relatively young adults hanging out on the porches or in the parking lot. I don't understand why our society has made it rewarding not to work.
  3. by   mercyteapot
    Quote from grammyr
    Here's a scenario:

    Father is a pharmacist, mother is a nurse and healthy boy is on Medicaid.

    Is that abuse???:angryfire
    Not necessarily. There are conditions that are so expensive to treat, that at least in California, there are income waivers. If treating the illness/disorder is expected to cost more than 20% of a family's income, the child can qualify.
  4. by   Nurse Ratched
    Folks - a couple of posts have been problematic (personal attacks) and I would ask everyone to be mindful of keeping the focus on the topic, not the other poster. I would also suggest that everyone's individual experiences color their opinions. Simply because you have not personally seen a situation doesn't mean it doesn't exist. Please don't discount your fellow posters' experiences.

    Also, there's a lot to be said for a good vent. We all have difficult jobs - please at least allow everyone the ability to gripe about it a little without being attacked for it. It's not aimed at anyone here, even if the situations may hit a little close to home.
  5. by   grammyr
    Quote from mercyteapot
    Not necessarily. There are conditions that are so expensive to treat, that at least in California, there are income waivers. If treating the illness/disorder is expected to cost more than 20% of a family's income, the child can qualify.
    If parents and grandparents talk about how blessed they are to have healthy grandchildren, I can only guess that there isn't an expensive or chronic illness to treat.

    I live in a small town, and nobody's kids get sick that everybody doesn't know it.

    The thing that burns me up personally about Medicaid is not that the people who get it that really do need it , its the people who need it that can't get it. My 5 year old granddaughter was diagnosed with diabetes last year and because my son makes about 2,000 a year too much money, they couldn't get any help for her. Yes, they have insurance, but the deductible is 1000 per person and they have to pay for meds and file for reimbursement. Strips are about $1 each and she has to do checks at least 4 times a day, so it doesn't take long for that to add up. I guess that's what grandparents are for.
  6. by   mercyteapot
    Quote from grammyr
    If parents and grandparents talk about how blessed they are to have healthy grandchildren, I can only guess that there isn't an expensive or chronic illness to treat.

    I live in a small town, and nobody's kids get sick that everybody doesn't know it.

    The thing that burns me up personally about Medicaid is not that the people who get it that really do need it , its the people who need it that can't get it. My 5 year old granddaughter was diagnosed with diabetes last year and because my son makes about 2,000 a year too much money, they couldn't get any help for her. Yes, they have insurance, but the deductible is 1000 per person and they have to pay for meds and file for reimbursement. Strips are about $1 each and she has to do checks at least 4 times a day, so it doesn't take long for that to add up. I guess that's what grandparents are for.
    Who can account for the things people say to others? Maybe the parents and grandparents are trying to hide the child's condition by bragging about how healthy s/he is. You say that no one gets sick in your small town without other people knowing it, but how can you be so sure of that? The very definition of keeping a secret is that no one else knows about it! OTOH, if the child is so healthy, he probably isn't costing Medicaid all that much anyway. The bottom line is that either these people are financially qualifying for Medicaid under legitimate waiver conditions, or there's more than abuse going on here, there's fraud. One last thought, if your granddaughter missed the Medicaid cutoff by only $2K, she should be eligible for Title V coverage. The qualifying income is much higher for that. As a last resort, what about SCHIP?
    Last edit by mercyteapot on Jan 10, '06
  7. by   grannynurse FNP student
    Quote from LeahJet
    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.
    I am sorry if you felt deceived but I had guessed that there was only one response because everyone had seen thru my subterfuge. You see, all one had to do was read a few of my prior posts and take a guess I was referring to myself. I was interested in learning what would be the take of several of my peers. It is also interesting that no additional information was sought but a value judgement was made on my daughter and for that matter myself. Value judgements that are made everyday by nurses over who is entitled to medicaid, who is abusing it, etc, based on the same amount of limited information.

    Grannynurse
  8. by   grannynurse FNP student
    Quote from LoriAlabamaRN
    I don't disagree that there are people out there who legitimately need welfare. It's the people that simply refuse to get a job and then turn around with their hand out that get to me. It's not that there aren't jobs available. Any fast food place will tell you that. It's just horribly unfair that some people work in horrible conditions for minimum wage when others make far more than that by living off the state.

    I live a few miles from a public housing complex that I pass by every night on my way into work. The parking area is full of cars, and I would say that mroe than half of those cars are newer than what I can afford to drive. I see groups of relatively young adults hanging out on the porches or in the parking lot. I don't understand why our society has made it rewarding not to work.

    Are people aware of the fact that most minimum wage jobs do not offer health insurance? And those who do, prenimums are too high for most to afford? And those that collect public assistance do not 'make more' then those working at minimum wage. Making minimum wage disqualifies anyone from receiving medicaid. The income is too much to receive medicaid, believe it or not. Perhaps we should research our own states requirements as to who qualifies and just how much public assistance really pays before making statements.

    Grannynurse
  9. by   irishnurse67
    Quote from grannynurse FNP student
    I am not disagreeing that there are abuses of Medicaid and Medicare and private and/or employer health insurance programs. I am questioning the rather outlandish claims, made by several posters. of abusers of Medicaid driving $30,000 cars, owing homes, wearing designer clothes. And even if some of their claims are true, such as the wearing of designer clothes, who and what is to say these were not purchased prior to their loss of income. I wore designer clothes when I was receiving Medicaid. Guess what? I had made the purchase of such clothes before I lost my income. To satisfy some, what am I suppose to do? Throw the clothes out and wear what? I think not and I think it is unreasonable to demand people dress down to suit some warp sense of propriety.

    Likewise I question people stating that those on food stamps buy better cuts of meat or spend them on items they themselves cannot afford. One needs to understand the food stamp program. It is not a free give away federal food program. You must purchase your food stamps. The purchase gives you a set increase in the amount of money you can spend on food. And what food you can purchase is also tightly regulated. And if one sees someone making purchases they suspect are not allowed, they have the obligation to speak to the store manager and/or the food stamp program. Like wise, WIC is also a federaL program that ensures that infants and toddlers receive juice, milk, cheese. And it is also a tightly regulated program. And if anyone sees a person violating that program, again they have the responsibility to report the store and the clerk Believe me, stores do not wish to lose their ability to accept WIC checks.

    As far as owing a home and receiving Medicaid. Most states have the following program in place. In order to be eligible for Medicaid and continue to own and live in your home, you must sign an agreement that turns the home over to the state upon the death of the eligible individual and his/her spouse. It is an old and established rule and is accepted by many eligible individuals. So, that explains that situation.

    I take issue with misrepresentations, be they intentional or non-intentional, by some on this thread. I have offered explanations, as have others, yet none of you apparently are able to offer any reasonable exceptions to the rule. Instead offer more misrepresentations of what they have supposedly seen. And I have yet to see any offer steps they have taken with their own state legislature to correct those laws they take issue with. And please do not offer the busy life excuse. I have been active in politics since high school. And I have been a single mother, working full time and attending school full time, and still made the time. And I instilled my activism in my daughter, who is sometimes at odds with me politically.

    If you want to continue to offer incorrect assessments of supposed abuses, feel free to do so. Please do not complain when I and others take issue with your statements of supposed abusers, it only lessens your argument.

    Grannynurse
    G
    Last edit by irishnurse67 on Mar 27, '06
  10. by   grannynurse FNP student
    Quote from irishnurse67
    Grannynurse is right about the claim of Medicaid recipients driving $30,000 cars being outlandish (at least in the state of Massachusetts).

    Grannynurse is also right when she says that you have to sign an agreement that your house goes to "the state" if you die and you are a Medicaid recipient. I think that's pretty close to what she said. BUT, at least in the state of Massachusetts, if you go off Medicaid AND THEN sell your house, the proceeds are yours.

    She's also right in that people shouldn't be expected to sell their clothes. Selling unneccessary things, yes, cutting all but neccessary expenses, yes, But you can't go around naked!

    I don't know about food stamps in other states, but here in Massachusetts, the rule is that anything that can be eaten can be bought w/food stamps in a grocery store except for booze, or things that are ready-to-eat.

    Also, if you factor in Section 8 housing, food stamps, WIC, TANF, fuel assistance, phone bill reduction, child care vouchers and tuition/books for college, and Medicaid, I bet it pays more than a minimum-wage job!
    You are speaking of Massachusetts when you are discussing Section 8 housing, food stamps, WIC, TANF, fuel assistance, phone bill reduction, child care vouchers, tuition/books for college, and Medicaid. Here, in Florida, there is no such thing as fuel assistance, even reduction in electricity bills. You use FP & L, you pay for it. You run far enough behind, in your power bill, and can't get assistance from a non-public volunteer organization such as the Salvation Army, your power is shut off until you pay your bill in full and make the deposit that F P & L requires before your power is turned back on. Phone bill reduction, no such thing here. If you can afford a phone, you are responsible for paying it. And the phone companies down here expect payment in full. Here in Charlotte County, we have no Section 8 housing or public housing. A little storm name Charlie destroyed more then 70% of our rental housing, i.e. section 8 and all of our public housing, both for the elderly and families. Same goes for Hendry and Collier Counties. And those counties also lost their seasonal farm worker housing, as did De Soto County. Tuition/books for college, try vocational school first. A great many of our poor dropped out of school before graduation. Or were forced to drop out because of our great leader's No Child Left Behind program and his failure to adequately fund it.

    Medicaid, take a look at what Florida funds in their program. And how they restrict the number of prescriptions to six, and cover mostly generics only. And try to find a doctor who will accept you.

    I thought that a minimum wage job was the end all to earning a productive life. Guess I was wrong. And here, if you own your home, you sign it over to the state in order to get Medicaid. And you don't get your house back if you go off of Medicaid. Florida maintains the lien on your home. You may sell it but the state gets its money up front before you see one penny of it. I don't agree with many of Florida's social policies but they at least make sure they get their money back when ever they can. And they are short on their funding of social programs. And while housing may cost less then it does in your state, move down here and your property tax will be higher then it is up there. And your construction cost for a new home will be higher and good luck getting insurance. They are writing fewer and fewer policies and renewing fewer ones. And the impact fee you will have to pay, here in Charlotte County it is currently $8,000, for a new home. And we are the lowest in the state And forget the nice salary you and your hubby earn, you will take a significant drop.

    So, Medicaid gets abused. And there are some who abuse public assistance programs. But live a fine life, not on a bet. You will live a pretty poor life.

    Grannynurse
  11. by   $/satisfaction?
    Well, whenever you want to get more customers you lower the price and when ever you want less customers you raise the price. The easy entry into the medi system encourages people to remain in their current state. The amount of benefits they receive and the unlimited visits to the ED creates an environment that asks for abuse.

    FOr all those that pay for their insurance we have copays. THe copays are there to slow the use of the plan. THe insurance company's know that if the user did not contribute every time they sort to use the benefits the benefits would be used up at a higher rate.

    Giving something for free is nice but we need to start requiring compliance upon the holders of the medi cards. Such as a daily exercise program a course in nutrition etc. If we required something instead of NOTHING medi would not spend so much to care for the people. Remeber anything that is free you usually have contempt for those thing that cost you care for. Its time that we require some sort of action from the CARD holder. Untill then Medi will run wild with abuse.
  12. by   grannynurse FNP student
    Quote from $/satisfaction?
    Well, whenever you want to get more customers you lower the price and when ever you want less customers you raise the price. The easy entry into the medi system encourages people to remain in their current state. The amount of benefits they receive and the unlimited visits to the ED creates an environment that asks for abuse.

    FOr all those that pay for their insurance we have copays. THe copays are there to slow the use of the plan. THe insurance company's know that if the user did not contribute every time they sort to use the benefits the benefits would be used up at a higher rate.

    Giving something for free is nice but we need to start requiring compliance upon the holders of the medi cards. Such as a daily exercise program a course in nutrition etc. If we required something instead of NOTHING medi would not spend so much to care for the people. Remeber anything that is free you usually have contempt for those thing that cost you care for. Its time that we require some sort of action from the CARD holder. Untill then Medi will run wild with abuse.

    Lets see, no co-pays, unlimited access, unlimited benefits equals abuse of Medicaid. And this is based on what? Personal information? Personal experience? How about actually relying on actual research? And the comment about insurance companies and benefits being used at a higher rate causes higher cost, that is somewhat a lie, by the insurance companies. Higher cost, while they are somewhat tie into increased use, increased use is not totally responsible for the increase in cost. Increase in cost is also tie to the capital expenditures of service providers; reduction in fees; loss in profit margins; loss in stock earnings; to name a few.

    The purpose of co-payees and high deductibles, plus high premium is to discourage the policy holder from using his coverage. And by doing this, you decrease the expenditures of the insurance company and increase the profit of the insurance company. Lets face it, most health insurance companies exist to make a profit for the shareholders, providing coverage is incidental.
    One needs to examine the history of health insurance and the coverage provided before making blanket statements.

    And finally tieing in compliance into obtaining a Medicaid card. In case anyone has forgotten, this is still a free country. And forcing people into programs aimed at controlling their life, in the name of improving their health, it doesn't work. Are you going to force people to eat a proper diet, without taking their nationality into consideration? Are you going to force people to ex cerise, in hopes of shortening out possible diseases? Don't forget, you may increase their number of accidents and increase their use of services. Forcing people into taking action they may see little value in, for whatever reason, may work for a short time but studies have shown, in the long term to be a failure. Are you also going to require it of all people who pay for their health insurance. Even the insurance companies realize the fruitfulness of that attitude. Individuals pay higher rates. Groups spread the cost but still pay higher costs.

    Wouldn't it be wonderful if fixing the Medicaid system, the health care system, were that simple. Sorry, it is not but the sound bits sound nice don't they.

    Grannynurse
  13. by   mercyteapot
    I think the recipients and the providers that rely on Medi-Cal would laugh themselves silly at the notion that care is unlimited using this program (unless they're too busy crying, that is...)

close