Patients on Medicaid

Nurses Relations

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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.

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:

I agree with you. I have heard this nonsense for years. Occasionally-VERY OCCASIONALLY-I will hear of a welfare fraud prosecution. I wouldn't want to trade places with anyone whose life situation puts them on public assistance. I am grateful that I make enough money to not need public assistance.

When I was a child, my father became permanently disabled. We went from our nice upper middle class lifestyle, to on welfare and medicaid, after exhausting our own resources.

I can still remember being treated differently at doctors' offices. The only thing that changed was the medicaid card my parents had to present.

I would agree there there are some common problems among low income groups. That is just common sense. It is unfair to treat everyone on assistance as though they behave like some problem people, though. I remember that unfairness. It felt bad.

All I know is that if you treat people poorly that it tends to stimulate bad feelings which can lead to bad behaviors. I don't think that anyone should feel free to take potshots at people below them on the ladder. Bottom line is I think everyone is deserving of dignity and respect because they are people. We are all one catastrophic injury or illness away from having to live on public assistance.

Specializes in rehab; med/surg; l&d; peds/home care.

Maybe this doesn't belong here on this thread, but I just wanted to add. I was dx w/ uterine Ca in October, had a hysterectomy, and have been off work due to chemo since Christmas. I also have intractable pain (I can hear the groans now...) and take morphine every 6 hours.

I have two kids, 5 and 6. I applied three months after being out of work to receive food stamps for my kids. I was denied, even with a zero income. When my employer's insurance was to end, and COBRA begin, I couldn't get my kids on the state's 5/dollar a month program for health care. They told me I'd have to pay my COBRA, which is 1000 dollars a month. Meanwhile, I receive no child support, and was the sole support of my children.

I about to be evicted from my house. Welfare in this state is ridiculous. I have sold so much of my stuff to get money. I used up my 401k. The only way I have internet is when I go to my dad's house, so don't anybody think I am paying for internet.

I am so sick right now, I just want to die. I have tried to get every type of assistance, churches, nurses house, etc. Believe me, I tried EVERYTHING. Even contacted my state reps to get help. What did I get? A form letter. That's how much people in my state care about their people. I don't know if I'll ever be able to work again due to my pain. But I don't know what else to do. I just want my kids to have a decent meal in their belly before they have to go to bed. I have many times gone without a meal so they could eat. My parents try to help, but they live on a limited income themselves, and my dad is ill. I don't know what I'm going to do. There is no help in my state. When I tried to file for child support again, my stupid ex stopped working, cause his new girlfriend is working and pays for his expenses. Nice, huh? At least if I died, my kids would have a nice sum of money to pay for their needs. The only thing that stops me is that they would be going to that piece of scum, who likes to slap them around. I am caught between a rock and a hard place. And I would love to work, but my legs are numb, and my back is in pain 24/7 despite the morphine. I am down to walking with a walker, IF I can get up. Tomorrow is my son's first day of kindergarten, and I want to be there so badly, but I don't know if I'll be able to walk out to the car and then to his bus stop. My body is disintegrating before my eyes.

I know this probably doesn't belong here in this thread. But I just wish I COULD qualify for medicaid. Or just food stamps. I don't have a house or a car. I worked my butt off for 11 years as a nurse, and paid plenty in taxes, which went to help others. And now, when *I* need the help, I am denied, denied, denied. It makes me sick.

Oh boy, I've really rambled on here. Probably none of it even makes sense, so I apologize for that. I'll shut up now. Just wanted to let you know what it's like for someone who WISHES they could get medicaid.

Specializes in icu, er, transplant, case management, ps.
I agree with you. I have heard this nonsense for years. Occasionally-VERY OCCASIONALLY-I will hear of a welfare fraud prosecution. I wouldn't want to trade places with anyone whose life situation puts them on public assistance. I am grateful that I make enough money to not need public assistance.

In 1997 I was admitted to an HCA owned hospital for cervical surgery. I was dismissed 34 hours later. According to my doctor's orders, I was to be admitted as a regular patient. You can imagine my surprise when I received a telephone call from my car insurance company, telling me that they had submitted a bill of more then $50,000. I asked them not to pay it until I could check an itemized statement. Much to my surprise, HCA had billed me as a short stay patient, at more than $850 an hour. Here in Florida, short stay is defined as a stay less then 23 hours. I also found charges for IVs and drugs I never received, as well as several other questionable charges. I asked for a meeting with their CEO and went through my original orders, as well as the 'mistakes' in billing. I figured my bill should have come out to approximately $23,000. And demanded a new bill be submitted for that amount. It was.

A short time later, I received notification from Medicare of a bill being submitted for more then $30,000. I got in touch with them and told them what was going on. I also got in touch with our local FBI office, who just happen to be investigating HCA for fraud charges on Medicare. We had a nice little chat, where I laid everything out for them. They were duly impressed. I then informed them, I had done fraud and abuse investigations, in NYS, for Medicaid. And had worked with several others in connection with fraud in Medicare billing. To make a long story short, the CEO and the Chief Financial Officer were charged and later found guilty. And I had also conducted active and retrospective audits for WC insurance companies. And you would be surprised at the rip offs of them.

I have always asked for an itemized statement of any stay, regardless of who was paying. Not only are there people who cheat on welfare, there are doctors, hospitals and LTC facilities that also defraud the government. Everyone should ask for a itemized copy of their bill. And check it for accuracy. They just might be surprised.

Woody:balloons:

Specializes in icu, er, transplant, case management, ps.
Maybe this doesn't belong here on this thread, but I just wanted to add. I was dx w/ uterine Ca in October, had a hysterectomy, and have been off work due to chemo since Christmas. I also have intractable pain (I can hear the groans now...) and take morphine every 6 hours.

I have two kids, 5 and 6. I applied three months after being out of work to receive food stamps for my kids. I was denied, even with a zero income. When my employer's insurance was to end, and COBRA begin, I couldn't get my kids on the state's 5/dollar a month program for health care. They told me I'd have to pay my COBRA, which is 1000 dollars a month. Meanwhile, I receive no child support, and was the sole support of my children.

I about to be evicted from my house. Welfare in this state is ridiculous. I have sold so much of my stuff to get money. I used up my 401k. The only way I have internet is when I go to my dad's house, so don't anybody think I am paying for internet.

I am so sick right now, I just want to die. I have tried to get every type of assistance, churches, nurses house, etc. Believe me, I tried EVERYTHING. Even contacted my state reps to get help. What did I get? A form letter. That's how much people in my state care about their people. I don't know if I'll ever be able to work again due to my pain. But I don't know what else to do. I just want my kids to have a decent meal in their belly before they have to go to bed. I have many times gone without a meal so they could eat. My parents try to help, but they live on a limited income themselves, and my dad is ill. I don't know what I'm going to do. There is no help in my state. When I tried to file for child support again, my stupid ex stopped working, cause his new girlfriend is working and pays for his expenses. Nice, huh? At least if I died, my kids would have a nice sum of money to pay for their needs. The only thing that stops me is that they would be going to that piece of scum, who likes to slap them around. I am caught between a rock and a hard place. And I would love to work, but my legs are numb, and my back is in pain 24/7 despite the morphine. I am down to walking with a walker, IF I can get up. Tomorrow is my son's first day of kindergarten, and I want to be there so badly, but I don't know if I'll be able to walk out to the car and then to his bus stop. My body is disintegrating before my eyes.

I know this probably doesn't belong here in this thread. But I just wish I COULD qualify for medicaid. Or just food stamps. I don't have a house or a car. I worked my butt off for 11 years as a nurse, and paid plenty in taxes, which went to help others. And now, when *I* need the help, I am denied, denied, denied. It makes me sick.

Oh boy, I've really rambled on here. Probably none of it even makes sense, so I apologize for that. I'll shut up now. Just wanted to let you know what it's like for someone who WISHES they could get medicaid.

I don't know which state you live in but no state can force you to meet the cost of your COBRA. I strongly advise you to check with someone higher up the food chain. And also contact your state representatives and tell them what is going on. I know that some workers tell applicants out right lies to discourage them from applying. You have a right to apply. And if you are reject, the state has to inform you of why. And be eligible for COBRA coverage isn't a valid reason for rejection.

Woody

:heartbeat ((((((rehab nurse)))))) :heartbeat

Specializes in ER, ICU, L&D, OR.
I've had things thrown at me by some of the best educated, well paid individuals in the world. Income or lack of income has no bearing on one's attitudes or behavior. At least not in my experience.

Woody:balloons:

This brings so many thoughts to mind. Very thoughtfull response

Specializes in icu, er, transplant, case management, ps.

I've been waiting for an answer to my question, would someone please post the name of a city or town where all of these negative things happen with people being on welfare and stealing your hard earned tax dollar. Or atleast name a city where I can see all those dishes, on the roofs, of some many the welfare takers who do not manage their money properly. I am being serious in my request. If these problems are so wide spread, I would like to view them myself. Then perhaps I will stop being the bleeding heart liberal that I am.

Woody:balloons:

I've noticed that many low SES people are rude in general. I've worked many retail and nursing home jobs, and a significant portion of people stuck at the bottom stayed there for a reason: Their manners and work ethic were crap. This ensured a low income and thus Medicaid. Seriously, many people in the lower SES are taught that being street smart is the best skill one can have, and that no uppity jerk is going to tell them what to do. Yes, I'm generalizing, but it's what I've seen. Oh yeah, don't forget that whole, "The customer is always right," crap that ensures that anyone can be a Paris Hilton nowadays. Yes, I know that there's much more to lower SES than most people think (eg the welfare trap), but again, this is what I've seen.

I'd rather spend a lifetime with people living on welfare and medicaid than one minute with paris hilton :uhoh3:

Specializes in acute care.

Wow! my heart goes out to you and I hope and pray things get better. It's sad that my ex co-workers openly cheat the system and get away with it and people like you who NEED help cannot get it.

{{{{{{rehab nurse}}}}}}}

Maybe this doesn't belong here on this thread, but I just wanted to add. I was dx w/ uterine Ca in October, had a hysterectomy, and have been off work due to chemo since Christmas. I also have intractable pain (I can hear the groans now...) and take morphine every 6 hours.

I have two kids, 5 and 6. I applied three months after being out of work to receive food stamps for my kids. I was denied, even with a zero income. When my employer's insurance was to end, and COBRA begin, I couldn't get my kids on the state's 5/dollar a month program for health care. They told me I'd have to pay my COBRA, which is 1000 dollars a month. Meanwhile, I receive no child support, and was the sole support of my children.

I about to be evicted from my house. Welfare in this state is ridiculous. I have sold so much of my stuff to get money. I used up my 401k. The only way I have internet is when I go to my dad's house, so don't anybody think I am paying for internet.

I am so sick right now, I just want to die. I have tried to get every type of assistance, churches, nurses house, etc. Believe me, I tried EVERYTHING. Even contacted my state reps to get help. What did I get? A form letter. That's how much people in my state care about their people. I don't know if I'll ever be able to work again due to my pain. But I don't know what else to do. I just want my kids to have a decent meal in their belly before they have to go to bed. I have many times gone without a meal so they could eat. My parents try to help, but they live on a limited income themselves, and my dad is ill. I don't know what I'm going to do. There is no help in my state. When I tried to file for child support again, my stupid ex stopped working, cause his new girlfriend is working and pays for his expenses. Nice, huh? At least if I died, my kids would have a nice sum of money to pay for their needs. The only thing that stops me is that they would be going to that piece of scum, who likes to slap them around. I am caught between a rock and a hard place. And I would love to work, but my legs are numb, and my back is in pain 24/7 despite the morphine. I am down to walking with a walker, IF I can get up. Tomorrow is my son's first day of kindergarten, and I want to be there so badly, but I don't know if I'll be able to walk out to the car and then to his bus stop. My body is disintegrating before my eyes.

I know this probably doesn't belong here in this thread. But I just wish I COULD qualify for medicaid. Or just food stamps. I don't have a house or a car. I worked my butt off for 11 years as a nurse, and paid plenty in taxes, which went to help others. And now, when *I* need the help, I am denied, denied, denied. It makes me sick.

Oh boy, I've really rambled on here. Probably none of it even makes sense, so I apologize for that. I'll shut up now. Just wanted to let you know what it's like for someone who WISHES they could get medicaid.

WOW. usually i enjoy reading posts in these forums but i HAVE to tell you, this one is hitting way too close to home and some of you people are UNBELIEVABLE. I have TWO CHILDREN and one on the way. I have been on WIC and my kids are on MEDICAID. NOT EVERYONE who is getting government assistance is RUDE, OBNOXIOUS, ABUSING THE SYSTEM, or anything else you want to STEREOTYPE. i am a VERY HARD WORKING UNMARRIED MOTHER. I get my BUTT up and go to work EVERYDAY, FULL TIME im GOING TO SCHOOL, FULL TIME..... to better my children's lives and MY OWN. i think it's disgusting that i am working SO hard to go into a field that i love, and seeing the "behind the scenes" opinions of the SAME people I am trying to become.

DONT GET ME WRONG... i DO agree with some of the things that are said. there ARE lazy people sitting around collecting OUR HARD EARNED MONEY. THERE ARE rude obnoxious people around. but those people are not not only walking around with MEDICAID cards... some of them are walking around with LIMITLESS PLATINUM VISAS tucked behind there about-to-burst money clip.

:angryfire:angryfire:angryfire:angryfire

Specializes in LTC, Med/Surg, Peds, ICU, Tele.
WOW. usually i enjoy reading posts in these forums but i HAVE to tell you, this one is hitting way too close to home and some of you people are UNBELIEVABLE. I have TWO CHILDREN and one on the way. I have been on WIC and my kids are on MEDICAID. NOT EVERYONE who is getting government assistance is RUDE, OBNOXIOUS, ABUSING THE SYSTEM, or anything else you want to STEREOTYPE. i am a VERY HARD WORKING UNMARRIED MOTHER. I get my BUTT up and go to work EVERYDAY, FULL TIME im GOING TO SCHOOL, FULL TIME..... to better my children's lives and MY OWN. i think it's disgusting that i am working SO hard to go into a field that i love, and seeing the "behind the scenes" opinions of the SAME people I am trying to become.

DONT GET ME WRONG... i DO agree with some of the things that are said. there ARE lazy people sitting around collecting OUR HARD EARNED MONEY. THERE ARE rude obnoxious people around. but those people are not not only walking around with MEDICAID cards... some of them are walking around with LIMITLESS PLATINUM VISAS tucked behind there about-to-burst money clip.

:angryfire:angryfire:angryfire:angryfire

Wow, you sound pretty stressed out and resentful of people in different circumstances than yourself. Hopefully you will become accustomed to varying points of view before you begin your career as a nurse, since you'll be rubbing shoulders with all sorts, including people who have attained financial success, often through prudent planning and hard work.

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