Patients on Medicaid

[DiEd]

I hope not to offend anyone out there, but I would appreciate some feedback on taking care of young to middle-aged adults who are on medicaid. It seems that so many (I realize not all) are some of the most difficult patients to care for; they often are rude, demanding, and unappreciative of nursing care. I have cared for many who demand tests/procedures/an extra day or two in the hospital/supplies that they don't really need; doctors often admit to just giving them what they want, rather than arguing. I have had medicaid patients say to me after I suggest to them, they can probably purchase an item for cheaper at the store, "Oh I don't care, I'm on Medicaid". Recently, a woman openly admitted that she had another child because she wanted more Medicaid money. When a woman has six kids by different men, and lives off Medicaid, I asked myself, "how does this happen"; aren't there people out there monitoring this system". About a year or so ago, I was taking care of a woman - and because the census was extremely low, patient-nurse ratio was 2:1 (unusual but nice). Anyway, I took so much extra time visiting with, caring for and going way beyond what I really needed to do to ensure quality nursing care, and at lunch, her Diet Pepsi wasn't on her tray. She gets on the phone and proceeds to rant and rave about this to a friend. I could hear her end of the conversation. Yes, she was a Medicaid patient.

Wow, I was blown away and got quite upset. I can't believe these are isolated incidences. Many nurses I work with are able to identify Medicaid patients just by their behavior.

As I said earlier, I don't mean to offend, but I am interested to learn if others out there in the nursing world encounter the same type of thing. I realize it is not right to label or generalize people, and I don't let it affect how I care for people; I certainly don't like the way I feel when confronted with this behavior. Any responses are welcome.

Thanks.

[Elvish, BSN, DNP, RN, NP]

It is against the law for a patient's insurance info to be on ANY paperwork that makes it into the ER where I work, in California. The patients sign in with minimal info, are triaged and then seen in the ER and then go back to finish paperwork, where they present their insurance info.

That's very cool.

[jojotoo, RN]

It is against the law for a patient's insurance info to be on ANY paperwork that makes it into the ER where I work, in California. The patients sign in with minimal info, are triaged and then seen in the ER and then go back to finish paperwork, where they present their insurance info.

We never see what kind of insurance they have.

steph

Actually Steph, I don't think that's completely correct. What the law states is that medical care cannot be delayed by asking for financial info. Most ERs have taken that to mean that until the medical screening exam has been completed, financial info won't be requested. Now in my ER, the delay between the medical screening exam and dispo can be many, many hours. So at some point I do have access to the financial info. And sometimes I need it.

For example, I need to know if it's a Kaiser patient. Kaiser wants their own members transferred to Kaiser facilities. Then there are specific HMOs that want follow ups done with specific MDs. Also, since we are a private hospital, for the uninsured patient that must be admitted, I have to make a valid attempt to get him/ her transferred to a county facility. And the face sheet that has the insurance info also has the emergency contact on it. That I use quite bit.

[woody62, RN]

True...I suspect that she may have received more funds for welfare for the extra child, but I have not heard of receiving more Medicaid benefits.

But even the amount of money they receive, for a new baby, is minimal. In some states it is an average of as little as $50 a month. I am kind of tired of people complain that welfare moms just keep having more children so that they can get more money. The amount of money they receive is less then adequate. Even if they received $150 a month for each extra child, some apparently don't have the knowledge to understand what it really cost to fed, cloth and house a child.

I worked full time, while my daughter was a youngster. I allow my parents to be named as her formal guardians because, in this manner, my Dad, her grandfather, could put her on his federal health insurance. And I continued to give my parents an average of $150 a month, which back in the late 60's and 70's, was a lot of money. A lot of money that forced me to work overtime, while attending undergraduate and graduate school.

And in the 80s, when my daughter was a teenager, I gave my parents an average of $400 a month, plus paying for all of her clothes and the extras that a teenager needs. And when she entered college, we reached an agreement, she pay for her tuition and I paid for all the extras she needed, including her car insurance.

I am not look for a metal. But if things had been different, if I didn't have parents that earned a middle classes existence, if I didn't have a profession, if I didn't have the urge to find more education, my daughter's and my life would have been very different. I would be one of those individuals living in projects, off of welfare and having an income ot a poverty level. And my daughter would have turned out very different.

To be honest, I am tired of hearing of supposed individuals, driving $100,000 cars, living in upper middle class homes and eating the best. The rules for Medicaid prevent anyone from having a car as an assets worth that much. And most states impose a lien on homes, which when sold, must be satisfied before anyone else. And knowing the cost of owning a home, it is very unlikely that they could afford to keep up the payments on the home. I applied for Medicaid last August. My income was less than $2,500 but I was turned down. I made too much money on my SSDI and my annuity. The LTC facility is still waiting for their $14,000 payment. And they can continue to wait. The chain it is part of makes more then enough profit.

Woody:balloons:

[softstorms]

WOW. this is a strange thread. Having been on both sides from time to time. I would like to say some people behave loudly to cover some of their embarassment at being in that situation. Some do so just to do so, they need no reason. They have been this way and always will be.

But, it is not how they act that is a problem....it is how you react to it.

You can't change them, but you can change the way you look at it.

Just take a deep breath and say "THANK YOU" Then in your mind say "THANK YOU, I DON'T HAVE TO GO HOME WITH YOU" Then move on to the next one LOL

[GadgetRN71, ASN, RN]

I know of sevearal families that are multi-generational on welfare and I will take a picture of the tenement houses in the ghetto with the satillite dishes on them. The state in which I live is ridiculously lax with the welfare benefits. We actually have people coming in from New York, New Jersey etc because they can get right on the system here.

I stand by my belief that there are plenty of welfare cheats and at least in my state, they far outnumber the good, honest people that need some temporary help. I still say that if you are struggling, maybe you shouldn't keep having kids. Even if you don't get all that much extra money, is it fair to the child?

This is a hot button topic, I know. I'm not trying to change anyone's mind. Thankfully, in my state they are kicking a lot of families off of various benefits to save money. Maybe this will light a fire and motivate some of the lazy ones. I'll be happy if our state loses that "welfare utopia" status that it has now!

[EmmaG, RN]

I've actually had to ID these patients and when they show up multiple times a month and a year in the same car with their 3 kids strapped in their car seats I kind of know that the car belongs to them. I've known of neighbors that complain about it also because they live next to these people in this affluent suburb where I worked. I just don't think it is fair in any way whatsoever.

Thanks.

You just made my point

[teeituptom, BSN, RN]

I hope she called the police and had her arrested and prosecuted for assault and battery. No one should be allowed to get away with that type of behavior.

Woody:balloons:

Why because she stood up for rights, when the store manager unjustly told her that she couldnt use the coupons for her childs wishes. That is sad.

[teeituptom, BSN, RN]

The only thing that aggravates me about medicaid patients stems from when I worked as a pharmacy tech while in nursing school. When patients would come through the drive thru in their 60,000 dollar mercedes or bmws and be on medicaid. Now how the hell did they pull that off? And then they get upset when their over the counter meds aren't covered. Kiss my rear! I had no insurance at the time and had to cater to these liars. It really upset me.:angryfire

Why should it upset you. Yes its frustrating but you dont dont their individual stories their may be excellent reasons.

[teeituptom, BSN, RN]

i once worked with a cna who 'appeared' to live well.....nice house, gorgeous car, her kids w/designer clothes.

she was quite verbal about being on section 8, receiving public assistance, medicaid.

i asked her what her secret was.

she said something to the effect of, "i know every single system and loophole, here in america".

wonder what that means?

leslie

Write a book on it and become rich

[teeituptom, BSN, RN]

I was a junior in a diploma program, in 1965, when Medicare/Medicaid came into being. I remember all the dire warnings about both programs be a sign of socialized medicine. And we were all going to hell in a hand basket. Funny how things changed over the years. I have seen numerous people on Medicaid. And I have had to help numerous people on welfare. Funny thing, I have never seen anyone living high on the hog off welfare payments. I've never seen them in the supermarket buying prime rib and other expensive food items. And I have never seen them in top of the line, designer clothing. But I have read about them, not only here but on other messages boards. Would some one do me a favor. Please post a place, here in Florida, that I can go witness these people for myself.

The people I have seen, on Medicaid, myself included, didn't have the money to buy or even lease $100,000 cars. And they weren't dressed in designer clothing. And most of them live in the projects, both in New York City, and here in Florida. Sorry if I sound like I am doubting you all. If you know someone is cheating the system, it doesn't matter if it is a friend or relative, you have the obligation to report them to your state's Attorney General Office, as well as your local representative, both state and federal. It might take a couple of times of complaining, but I'm sure if you complain long and loud enough, someone will look into it. And if they don't, there is always the New York Times. I know a reporter on it.

Woody:balloons:

That was back during the height of cold war, and everyone was yelling against socialism, communism and all those other isms. And we used to complain about 'Big Brother" watching us. Now he really does all the time. Scary.

[teeituptom, BSN, RN]

I'll tell you what. I am usually so busy that I don't get 45 seconds to go take a much-needed pee break. So I'll be damned if I'm going to look through somebody's chart just to see what their insurance status is and then complain about it. Got better things to do.

There are people in every group who will try to take advantage of a system that was originally designed to help those who need it. There are people of all walks of life who are snooty, demanding, entitled, and think their excrement doesn't stink. And there are people of all walks who are grateful, gracious, kind, and generous. Bottom line -- I don't know people's insurance, and I really don't care.

Its boring to check. Recently I did check the information on one guy who really was being rude and obnoxious and drunkenly belligerent. I found out I was right.

He was a scummy attorney

[teeituptom, BSN, RN]

I've actually had to ID these patients and when they show up multiple times a month and a year in the same car with their 3 kids strapped in their car seats I kind of know that the car belongs to them. I've known of neighbors that complain about it also because they live next to these people in this affluent suburb where I worked. I just don't think it is fair in any way whatsoever.

why are they complaining

what are they complaining about

and what isnt fair about it.