Medicaid. Is it being abused?

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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?

As a mentioned in a subsequent post my parents pay my cable/internet and they are helping with my car note. I use internet for school (research and such for papers) and my basic cable is a luxury I can't afford but my kind parents are providing me. It is terribly difficult going from being able to live a comfortable life to having to decide between laundry detergent and dish washing liquid. My parents understand this, and while I don't expect them to take care of me, they still think I should not have to sit in a cold bare room with a bare lightbulb and a can of pork and beans because my husband fell upon unfortunate circumstances. Furthermore, I am going to school for my LPN and then RN, so it's not like I am making a life of my current situation.

:uhoh3: God bless you all, and I hope you never have to deal with a financial hardship. :)

If I were in that situation, I would ask my parents to give money instead to go toward groceries, so that perhaps the taxpayers wouldn't have to support you. That may sound harsh, but you can survive without cable, and without internet access. When you can't afford it, the luxuries should stop before the public assistance starts. I'm obviously not saying that you should "sit in a cold bare room with a lightbulb and a can of pork and beans", but if you honestly can't afford BOTH dish soap and laundry detergent, then maybe local television stations aren't so bad. I used the computers at my school and the local library, did not have cable, and used the $100 or so to buy the necessities.

As someone who has struggled VERY hard to get to where I am in life, I find it difficult to comprehend the "desperately poor" people who live off of MY tax dollars while keeping internet and cable services. I didn't have either until after nursing school. Heck, for 7 months I had no phone.

It would be very easy for me to go on disability. I broke my back many years ago in a car accident, and have permanent spinal damage and pain because of it. I have an autoimmune disorder with chronic fatigue syndrome. It would be very easy for me to file the paperwork, go on disability at age 29, point to my medical reasons and sniffle while I eat the junk food my food stamps buy and watch cable and hang out on the internet.

But you know what? I was raised better than that.

It's a pity so many people weren't.

Sorry but I am one of those evil individual's who is using everyone's tax dollars to live high off the hog. I don't have cable TV, can't afford it. Don't get food stamps either, my SSDI income is too much. Will have to pay for my Medicare Part D, just as soon as I figure out which one I can afford and which will work best for me. Of course, my Medicare prenimum is up to $88 plus dollars per month but what the heck, it pays 80% of my bill. And my medications only run me a little more then $400 a month but what the heck, with that and the repayment of my student loans, it leaves me with just $600 a month to throw away on your economy. Woops, forgot about my car insurance for my 14 year old car, which I need given the lack of public transportation here in sunny SW Florida. And I almost forgot, the $250 a month I give my daughter and SIL for allowing me to live with them, it is the least I can do.

I have been on SSDI since I was 42 years old. Prior to going on it, I lost everything I had worked so hard to get, my condo, my IRA, my car, my savings but what the heck I am getting your tax dollards. Sorry, am not. Paid all of my own federal taxes for ten years prior to my accident. That means I paid the full amount of FICCA, no employer contributing like most of you. And since I've always worked two jobs, I've always had to pay the max for FICCA. Despite what some of you think and maintain, the majority of people living on SSDI do not receive Medicaid or any state welfare. And the majority were tax payers, just like you, before they had to accept SSDI. And the majority have lost their homes, lost their life styles, lost their savings. And the majority of us are just barely getting by. I would like to invite any of you, to live on your own, on $1296 a month. Try paying your morage or rent, for food, bills, medications, Medicare, etc and see how far you get. By the way, my access to the internet is gradius of my daughter, she pays for it. And I piggyback off of her access.

Stop complaining so much and volunteer in a soup kitchen or in your juvenile court system, like I do. Then you would have nothing to complain about. You would thank your stars for what you have.

Grannynurse

If you see or know of Medicaid abuse there is usually a hotline to call to report it.

How is that affected by HIPPA...or is it? I was @ work the other night and a patient came in to get a RX filled and handed me her Aetna insurance card and her Medicaide card and told me to "try both and use the cheaper one.":angryfire I informed her that if she had a form of insurance other than Medicaide I HAD to use the alternate form and of course she got ticked. It made me so mad...but if I were to report something like that, would I be violating HIPPA? Just curious.

Specializes in Public Health, DEI.

I don't think there's a single entitlement (other than public education, I guess) that isn't prone to abuse. You betcha Medicaid is abused. I'd prefer that the politicians that keep harping on that as a reason to eliminate the assistance would instead spend the time and $ to create systems that are harder to beat.

Specializes in Public Health, DEI.
How is that affected by HIPPA...or is it? I was @ work the other night and a patient came in to get a RX filled and handed me her Aetna insurance card and her Medicaide card and told me to "try both and use the cheaper one.":angryfire I informed her that if she had a form of insurance other than Medicaide I HAD to use the alternate form and of course she got ticked. It made me so mad...but if I were to report something like that, would I be violating HIPPA? Just curious.

To answer your question, I'm not sure you'd be violating HIPAA if you didn't disclose any information about her condition or dx. That's just my guess, though, I really have no idea. More to the point, I wonder what you think the point of reporting her would be. What do you think they're going to do to her for asking a question? She didn't commit any fraud.

In 1990, I was thinking about getting married and having a baby. I'd just had a kidney transplant two years before and still had Medicare and CommonHealth (the Medicaid for working people). The transplant clinic told me I should be able to have a 'normal' life after getting the kidney-- and that included having a family.

I called the Medicaid office to find out if getting married would affect how much I had to pay per month.

"It sure will-- we'll drop you!" the office worker replied. "If you get married, your joint income will be over the program limits. But..." she said, "You can still have a baby... just don't get married! We'll pay your rent, and you'll get WIC, diapers, a corificeat, a crib, baby formula, and baby clothes."

"So you're telling me to have an illegitimate baby," I said.

"If you want any financial help, you can't get married!" was her answer.

So much for living a 'normal' life after a transplant! I didn't get married-- and also didn't have any children. The kidney rejected a year later and I went back on dialysis.

I am really not surprised that so many unmarried women have kids on Medicaid-- the workers practically call you an idiot if you don't go for it.

Specializes in Ante-Intra-Postpartum, Post Gyne.

I had a patient on Medicaid (well medi-cal here in California) drive up in a 40,000 dollar truck and then complain that he thought that his wife was going to get their 300,000 house in the divorce.

But these are my favorite. The patients that come in and cost the state about 80.00 per visit that come in asking for a Rx for cough medicine that they could easily get over the counter, but if it comes in a written order from the doctor medicade/medi-cal will pay for it.:madface:

To answer your question, I'm not sure you'd be violating HIPAA if you didn't disclose any information about her condition or dx. That's just my guess, though, I really have no idea. More to the point, I wonder what you think the point of reporting her would be. What do you think they're going to do to her for asking a question? She didn't commit any fraud.

Would it not have been fraud if she had used Medicaid when she already had another form of health insurance? She didn't commit fraud, but was attempting to as you are not supposed to have Medicaid if you already have health insurance. I may be wrong, but I am under the impression Medicaid is for people who do not have and cannot afford health insurance...not for people who already have and just want something that will get them their meds for free or for 50-cents.

Specializes in Public Health, DEI.
Would it not have been fraud if she had used Medicaid when she already had another form of health insurance? She didn't commit fraud, but was attempting to as you are not supposed to have Medicaid if you already have health insurance. I may be wrong, but I am under the impression Medicaid is for people who do not have and cannot afford health insurance...not for people who already have and just want something that will get them their meds for free or for 50-cents.

I guess if she had used Medicaid, without telling you that she also had Aetna, that would be a violation of some rule. Asking the question, in and of itself, can't be construed as a violation, IMHO. I do know that there are situations where people have both private insurance and Medicaid.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I, too, was told once to have another baby to be eligible for daycare assistance when I was a fulltime student. I was told very clearly by the caseworker "all kinds of goodies awaited me" if I would just have one more baby.

I was appalled. All I wanted was help w/the outrageous cost of daycare so I could graduate and be employed, not "goodies". So yea, you bet like Mercy said, there ARE abuses. And they are ENCOURAGED by some workers to ABUSE the system and HOW TO DO IT. It angers me to no end.

I, too, fell the need to respond to this. Both of my children are on medicaid right now, and although I am grateful it exhists, I think that medicaid patients may not be recieving equal treatment. My kids have had to wait for appointments to see doctors. I have to take them to the charity hospitals for specialist appointments and wait HOURS to see the doctor. I feel for the doctors that accept medicaid....they are stretched so thin they do not have time to sit down and discuss concerns. My daughter did not have her heart defect diagnosed until she was 4 months old. This was because by then she was so sick she almost died. I brought her to the doctor so often but her doctor just tried to minimize my concern. I cannot wait for the day I can get them on "real" insurance so that they may be treated like human beings. I have no doubt that people abuse medicaid...but if I could afford insurance, I would much rather have it than medicaid!:madface:

Specializes in Public Health, DEI.
I, too, fell the need to respond to this. Both of my children are on medicaid right now, and although I am grateful it exhists, I think that medicaid patients may not be recieving equal treatment. My kids have had to wait for appointments to see doctors. I have to take them to the charity hospitals for specialist appointments and wait HOURS to see the doctor. I feel for the doctors that accept medicaid....they are stretched so thin they do not have time to sit down and discuss concerns. My daughter did not have her heart defect diagnosed until she was 4 months old. This was because by then she was so sick she almost died. I brought her to the doctor so often but her doctor just tried to minimize my concern. I cannot wait for the day I can get them on "real" insurance so that they may be treated like human beings. I have no doubt that people abuse medicaid...but if I could afford insurance, I would much rather have it than medicaid!:madface:

Don't hold your breath hoping that the specialist situation will improve much once you're on regular insurance. I haven't found HMOs to be any better, and in some cases they are considerably worse, than Medicaid coverage. And at least where I live, HMOs are much more common than indemnity plans. For example, here in CA, the children who receive physical or occupational therapy via a Title V Medical Therapy Program can only have program assessments from the specialists if they have either Medi-Cal (our version of Medicaid) or indemnity insurance. No HMOs allowed. What the h*** is that??!! Also, again at least in CA, the Medi-Cal reimbursement rate for specialists is so abysmal (and many children who need specialists qualify for Medi-Cal waivers based on coverage limits of any private insurance they may have through their parents) that many of these specialists have said forget it, and left the state all together. Of course, that means that they are no longer available for any child, insured or not.

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