Medicaid. Is it being abused?

Specialties Emergency

Published

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 in designer clothes and lots of gold jewelry and they are on medicaid. I know of many who are the working middle class who are struggling to pay their own insurance premiums. Why do so many folks get a free ride? Or am I missing something here?

I take SWFlorida's post as a bit offensive. I am 19 years old and I got pregnant when I was 18. I was practicing the correct birth control but things happen. I had to go and get Medicaid for myself and my child because I didn't make enough money with the job I had and my parents weren't going to pay for medical bills once they found out how much it would cost them. I DO NOT in ANY WAY think I am irresponsable just because I got pregnant at a young age and needed some help. I could understand where your coming from if the teenager has no job or stability. But I needed that medicaid help . I support my child on my own without help from parents and I have a job AND am in Nursing school making good grades and my son is the healthiest. If you think people are a BURDEN to society because they have children out of wedlock than its your own opinion I guess. But what about those of us who are RESPONSABLE? I dunno. Reading this just really upset me and hit a nerve because I take care of my son and am not irresponsable in ANY way shape or form. If I am an underachiever dear god please tell me how.

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You know I would really like to see all the patients who abuse Medicaid, truly I would. I have been a nurse since Medicaid came into being. I have worked in ERs, in a large city and some very small ones. And I have never had the time to check the face sheet, let alone know who was paying the bill. As a matter of fact, I've never seen any of the type of patients that I have seen discribed here. I guess they never came into Kings County or Met, or Elmhurst, in New York City. Or for that matter, Englewood, Manatee or Doctors Hospitals here in Florida. Guess I was just unlucky.

Grannynurse:balloons:

Well...when you work in an ER that is so small that the nurses take care of doing the admission paperwork (putting informaiton in the computers, copying the insurance cards, etc) you know what type of insurance people have. We also had a bit of an obligation to check insurance because certain providers didn't cover things like portable x-rays (so we would make sure the patient went to the department), ACE bandages (so we made sure the dcotor ordered a cock-up splint), and certan medications. It was a benefit to our patient when we could tell the doctor, "Hey...this won't be covered by their insurance...would you consider _____ instead?"

I think a lot of it is a regional thing. The hospital where I did my paramedic clinicals did a lot of education about appropriate use of ER...here, they have such a "the customer is always right" attitude that they don't...anything goes in the ER. I think some things like "Ask-a-Nurse" or walk in clinics help keep the overuse of ER to a minumum, but that is something else we don't have here. We also have a HUGE population of people on Medicaid...last year over 70% of out patients were on Medicaid.

I think a lot of the abuse could be handled with education...also if there were a truly objective way to determine what is an emergency and what is not, I think requiring a copay would help. One of the nurses I used to work with is from Australia and she said that they are a lot more liberal about giving advice on the telephone so that most people try things at home before coming to the ER...that would also help a lot.

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Specializes in ER, NICU, NSY and some other stuff.

Cotjockey, I experience many of the same things that you do. Every single shift I work.

I never even bother to look at face sheets. I do not care what a person's paysource is.

If I find out someone is medicaid it is because they have offered this info. "Tell that doctor to prescribe me something different, my card won't pay for that." "Can you guys get this filled for me, I have already used all my punches this month." This while having spent at LEAST an amount equal to the cost of the prescription at the vending machine, in addition to the cigarettes they have mad a half a dozen trips outside to smoke. I do not care if they have soda or cigarettes What I am saying here is if you can afford them it should be AFTER you have paid for your child's amoxil.

My complaint would not be that people are on assistance so much in HOW they utilize it. In my state you are assigned a PCP. USE THEM for your mild illness not the local ER.

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I take SWFlorida's post as a bit offensive. I am 19 years old and I got pregnant when I was 18. I was practicing the correct birth control but things happen. I had to go and get Medicaid for myself and my child because I didn't make enough money with the job I had and my parents weren't going to pay for medical bills once they found out how much it would cost them. I DO NOT in ANY WAY think I am irresponsable just because I got pregnant at a young age and needed some help. I could understand where your coming from if the teenager has no job or stability. But I needed that medicaid help . I support my child on my own without help from parents and I have a job AND am in Nursing school making good grades and my son is the healthiest. If you think people are a BURDEN to society because they have children out of wedlock than its your own opinion I guess. But what about those of us who are RESPONSABLE? I dunno. Reading this just really upset me and hit a nerve because I take care of my son and am not irresponsable in ANY way shape or form. If I am an underachiever dear god please tell me how.

I'm sorry but are you responding to my post? I was not slamming SW Florida, just as I was not slamming NYC. Nor was I slamming anyone on Medicaid or Medicare. And I never have, for several reasons. I began my training when neither program was in place, when family members were responsible for the payment of parents hospital bills. When you had to pre-pay before you could be admitted for surgery And I have received Medicaid twice in my life, at the birth of my daughter and following a bed accident. And I have never seen any of the fraud that I have read about or heard about. And I have repeadly challenged anyone who has to report it and have had no takers. I have been accused as fraudently collect SSDI because I can sit at a computor and go to grad classes. The person making such accusations has never once reported me, even when she knew my correct name. I am very tired of reading over and over of these people who misuse or obtain Medicaid. Like I have said, report them, if you truly believe what you are saying.

Grannynurse

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Specializes in Public Health, DEI.
I'm sorry but are you responding to my post? I was not slamming SW Florida, just as I was not slamming NYC. Nor was I slamming anyone on Medicaid or Medicare. And I never have, for several reasons. I began my training when neither program was in place, when family members were responsible for the payment of parents hospital bills. When you had to pre-pay before you could be admitted for surgery And I have received Medicaid twice in my life, at the birth of my daughter and following a bed accident. And I have never seen any of the fraud that I have read about or heard about. And I have repeadly challenged anyone who has to report it and have had no takers. I have been accused as fraudently collect SSDI because I can sit at a computor and go to grad classes. The person making such accusations has never once reported me, even when she knew my correct name. I am very tired of reading over and over of these people who misuse or obtain Medicaid. Like I have said, report them, if you truly believe what you are saying.

Grannynurse

I don't think her response was to your post, but to the various posts that keep alleging fraud because some people on Medicaid seem to live beyond their means ("seem" being the operative word, because, really, who knows). I also think it is interesting that the question is about "abuse" and the conversation keeps turning to "fraud". Some of us are talking about basic misuse, meaning visiting the ER when a PCP visit (or good old common sense) is appropriate. Others are alleging deception and malfeasance. I would say that yes, this system, like all others, is sometimes abused. And I'm sure there is some fraud, too. You hear a lot more about it on the part of providers and patients, or MC workers and patients, or MC workers and providers, who are in collusion, though. It makes no sense that any great percentage of people who manage to pass the eligibility test are actually living in the circumstances that have been alleged on this board.

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Specializes in LTC, Psych, M/S.

I believe in CA that once you do get on welfare there is a cap on the grant, meaning a time limit as to how long you amy receive help (5 yrs I think) that is long overdue. Around here they are training the welfare moms to be CNAs!

Laura

Good for the state of Cali......reading this takes me back to a couple years ago when I was working as a CNA. I ran into a h.s. friend of mine who was working in a retail store. We were talking, she told me she had a baby and was a single parent - probably got medicaid, I'm sure she would have qualified. She said she was having a hard time making it with this job since she only got scheduled for 17hrs a week and made like 5.70/hr.

I told her to come work with me, I would help her get hired there. The LTC I was working for was desperate for CNA's and she could work fulltime, $8.00/hr.

Her response..."Oh, I would NEVER do that type of job."

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No I wasn't posting in response to yours. I ment to reply to a post that was on the first page of the forum. lol. Sorry if it caused any confusion. SWFlorida has made a post that was on the first page and it just hit a nerve. Sorry if my post seems a bit harsh. :)

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Specializes in Public Health, DEI.

The cap on lifetime welfare benefits isn't limited to California, it is a federal provision. States do run their programs differently, but certain guidelines apply across the board.

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Several of us brought up our concerns to our manager and were told to stay out of it. She agreed that there was abuse / misuse, but felt that it was not our place to report it...she did turn over several charts to risk management, but we never knew where they went from there...

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Several of us brought up our concerns to our manager and were told to stay out of it. She agreed that there was abuse / misuse, but felt that it was not our place to report it...she did turn over several charts to risk management, but we never knew where they went from there...

Sorry but your manager needs to update her information. And it should be reported not only to risk management but to the responsible state agency. And the reporting can be done by anyone. I had the experience of questioning a hospital bill, being told they would straight it out and then having them submit the uncorrected bill, twice. Guess it was a little clerical error.:nono:

Grannynurse

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I don't think her response was to your post, but to the various posts that keep alleging fraud because some people on Medicaid seem to live beyond their means ("seem" being the operative word, because, really, who knows). I also think it is interesting that the question is about "abuse" and the conversation keeps turning to "fraud". Some of us are talking about basic misuse, meaning visiting the ER when a PCP visit (or good old common sense) is appropriate. Others are alleging deception and malfeasance. I would say that yes, this system, like all others, is sometimes abused. And I'm sure there is some fraud, too. You hear a lot more about it on the part of providers and patients, or MC workers and patients, or MC workers and providers, who are in collusion, though. It makes no sense that any great percentage of people who manage to pass the eligibility test are actually living in the circumstances that have been alleged on this board.

I am sure that there are some who feel that some of my ER visits are misuse of my Medicare coverage. I stayed away from Managed Care Medicare because I would have had to speak with someone and get approval before seeking out treatment. Ever wonder why people use the ER as their primary source of care? Most because they can't find a physician or when they call are told they can have an appointment in a week or because one or both parents work, or the person just gets worse. I may have problems breathing during the day but resist going in because my rescue inhaler works for a while. And generally my breathing difficult gets worse in the evening or night. Generally I get yelled at for driving myself in and not coming in sooner. Can't win for losing.

I never had a problem in dealing with a patient who came into the ER for treatment of whatever their problem was. It wasn't my place to sit in judgement of why a patient came into my ER, it was my place to treat them. I am just so tired of hearing about all this alleged abuse, misuse and/or fraud on the part of people who receive second rate care and wait hours, in an ER.

Enough said.

Grannynurse

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No I wasn't posting in response to yours. I ment to reply to a post that was on the first page of the forum. lol. Sorry if it caused any confusion. SWFlorida has made a post that was on the first page and it just hit a nerve. Sorry if my post seems a bit harsh. :)

No problem. I also live and have worked in SW Florida. I understand why you were upset. For a young person, you show remarkable insight:wink2: I just wonder how some can have the time. I understand, from one poster, she works in an extremely small hospital and wears several hats. I worked in a 150 bed hospital, back in 1980 but we always had a clerk, on all three shifts, in th ER. And as I have already posted, it is not my place to judge why someone uses the ER as their PCP but to treat them. And if their is time, educate them.

Grannynurse

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