Medicaid. Is it being abused?

Specialties Emergency

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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?

Specializes in Occ health, Med/surg, ER.

quote=treddrn]I just hope that people will realize that the average family in America is about 2-3 paychecks away from being homeless. How many checks, if you lost your job, will it take for you to qualify for Medicaid. For most, 1 month. Just think again, how many paychecks are you from the POOR HOUSE?

Here's my story. I worked for a company for 6 years, the two of those years I went to school to get my general classes out of the way for the nursing program. I was the primary "breadwinner" for my household. I had insurance through my job. I got accepted into the program and I quit once they could not work with my nursing school hours. I tried to get medicaid for myself and my son and food stamps, which I was given. However they did not recertify the medicaid or food stamps for my son and I because I wasnt working, I would have to work 20 hours a week (my nursing school didnt count, not even my clinical hours). I'm mad because I worked hard for 6 years, single mom, never asked for a thing from the government. Then when I wanted to go to school to make my situation better, I couldnt get help. There are girls who have umpteen kids, housing and food stamps to feed an army. It just doesnt make sense. I just graduated LVN school and I cant even afford to pay for boards. It sucks.

Specializes in Infection Preventionist/ Occ Health.

I know someone who is on Medicaid, lives in a rent-assisted apartment, receives day care assistance and receives free school as well. This is all because she had a baby out of wedlock at a young age. The kicker is that her live-boyfriend has his mail sent to his parents house because they would kick her out if they found out he was living there. She works as a waitress and doesn't report her part of her tip money to keep her income down. Then, she walks around wearing designer clothes and Nike Shox shoes at over $100 per pair... This is abuse of the system if I ever saw it, but she doesn't see anything wrong with it!

As others have stated, she would lose all her benefits if she got married, so she chooses not to. The government is providing a strong incentive for girls to have out-of-wedlock babies IMO.

I know other girls of middle class families who go on assistance when they get pregnant- even though their parents could easily afford to help them out. Their parents are the ones who are encouraging it in most cases. Heaven forbid they should have to give up their vacation home or postpone putting a new deck on the house!

My parents were divorced when I was young and my dad took off after running up the credit cards and causing foreclosure on the house. My mother took a full-time job (and later a second job) and my grandparents watched us some days to save on day care expenses. Even when things were tight, we never were on any kind of assistance. My clothes came from JC Penny Outlet or the thrift store and our shoes were from Payless, and I didn't have cable until I lived in the dorms at college. My sister and I had to go to school early in the mornings to use the computer, because we did not have one at home. I feel that my mother set an excellent example for my sister and me. I credit her for my strong work ethic and my ability to live within my means.

I believe in receiving short-term help if you really need it, but many people apply for assistance as a FIRST instead of a LAST option or abuse the system (as in the example above). Medicaid and other forms of aid should be reserved for those who are disabled themselves or have disabled children, those who legitimately cannot work, or for the working poor IMO.

My children are on Medicaid, but the doctors in the county we live in refuse to take any new patients, and the charity doctors office is not accepting any new patients due to being overfull. We have to drive to a different county so I could get them into the doctors. I know this is due to the state not paying the bills when they come in. I don't take my children to the doctor for every sniffle, only for their annuals and probably once or twice during the year for other illnesses. I have a cousin, though, that is on Medicaid and takes her children to the ER everytime their temperature goes above 100. And she has a regular pediatrician. I just don't understand it.

Specializes in Neonatal ICU (Cardiothoracic).

OK, I've never been on any type of government assistance, but have seen how when used properly, can be a "stepping stone." What I have a problem with is the obvious abuse of the system by illegal aliens. Not only do they pay NO taxes of any kind, but they come by droves into the hospital, birth their babies on american soil, then leave with WIC, Medicaid, free assistance, now "protected citizens" b/c their kid was born here. We had a mom come in, birth twins on a "two week visit from Mexico" [who travels when they're 7 mos pregnant to another country?] and leave, her kids 3 million dollar-plus medical bills paid for by the taxpayers of the USA. She never paid a tax dollar in her life. I don't have so much of a problem with people using the system if they are a contributing member of society, but freeloaders and illegals get no sympathy from me.

Specializes in Public Health, DEI.
OK, I've never been on any type of government assistance, but have seen how when used properly, can be a "stepping stone." What I have a problem with is the obvious abuse of the system by illegal aliens. Not only do they pay NO taxes of any kind, but they come by droves into the hospital, birth their babies on american soil, then leave with WIC, Medicaid, free assistance, now "protected citizens" b/c their kid was born here. We had a mom come in, birth twins on a "two week visit from Mexico" [who travels when they're 7 mos pregnant to another country?] and leave, her kids 3 million dollar-plus medical bills paid for by the taxpayers of the USA. She never paid a tax dollar in her life. I don't have so much of a problem with people using the system if they are a contributing member of society, but freeloaders and illegals get no sympathy from me.

You're citing an example of a woman covered by emergency Medicaid, and the laws concerning that coverage aren't likely to change, ever. If public hospitals are compelled to treat women who present in imminent labor, the only thing shutting down emergency Medicaid would ever do is sock individual hospitals with the cost of their care. That would then endanger the entire surrounding community, who needs that hospital which may have to shut down, instead of spreading the cost of care across the system, as it must be. As far as undocumented immigrants lack of contribution to our economy, I don't buy it for a minute. Tons of them work illegally in agriculture, restaurants and factories, paying taxes under dummy SS #s, doing jobs no American citizen wants. They will never reap the benefits of those contributions the way the rest of us will. It is hardly a black and white issue.

I must agree that a lot of people are abusing the Medicaid. I actually know a person whose doing this fraud. Imagine, her husband is working in a contruction and earning more or less $32K/year. That is the amount that my husband is earning too but we have to pay the doctor per visit $20 as co-pay b/c we have an HMO. Then I asked her if she paid any amount everytime she goes to the her son's pedia and she said no. Another thing, a nurse is visiting his son when in fact nothing's wrong with him. When she gave birth to her son via C/S she didn't pay anything. Me on the other hand, delivered normal, I have to shell out $700+ b/c my insurance did not pay all. I guess this is very unfair to all American people paying their taxes on time and every year.

Do we have a moral obligation to tell somebody and expose the fraud they are doing? What is the right agency to tell so?

Specializes in Public Health, DEI.
I must agree that a lot of people are abusing the Medicaid. I actually know a person whose doing this fraud. Imagine, her husband is working in a contruction and earning more or less $32K/year. That is the amount that my husband is earning too but we have to pay the doctor per visit $20 as co-pay b/c we have an HMO. Then I asked her if she paid any amount everytime she goes to the her son's pedia and she said no. Another thing, a nurse is visiting his son when in fact nothing's wrong with him. When she gave birth to her son via C/S she didn't pay anything. Me on the other hand, delivered normal, I have to shell out $700+ b/c my insurance did not pay all. I guess this is very unfair to all American people paying their taxes on time and every year.

Do we have a moral obligation to tell somebody and expose the fraud they are doing? What is the right agency to tell so?

You don't have any proof that there is fraud. She may qualify for Medicaid under a waiver program. It is only fraud if she lied about her income on the application, and you haven't told us that any such thing has happened. As for the home visits, that may be something that is covered under your County's public health program. At any rate, it certainly doesn't sound fraudulent. If I was manning the phone of an agency you called and reported this limited information, I'd probably ask you what, exactly, it is that you think should be done.

You don't have any proof that there is fraud. She may qualify for Medicaid under a waiver program. It is only fraud if she lied about her income on the application, and you haven't told us that any such thing has happened. As for the home visits, that may be something that is covered under your County's public health program. At any rate, it certainly doesn't sound fraudulent. If I was manning the phone of an agency you called and reported this limited information, I'd probably ask you what, exactly, it is that you think should be done.

I would really like to see all these people who are receiving Medicaid fraudently, really I would. I live and worked in home health, in NYC, for several years and rarely if ever saw anyone obtaining benefits fraudently. And I never saw any of my clients driving big, fancy, new cars or the finer cuts of meat. I did have several who used dog food stew as a base for their own. And I worked as a rehab nurse/case manager, here in Florida, for ten years. And you would be surprised at the number of my clients that lived close to the edge or were pushed over it. I had several, who despite working forty hours, qualified for public housing and food stamps. And when they went on comp, qualified for Medicaid. I qualified for Medicaid for a whole 18 months, until I qualified for SSDI. Kind of hard to live on $296 a month.

To be honest with everyone, I am sick and tired of a few complaining about another few and acting like they were the majority. If you feel some one is receiving Medicare, Medicaid, food stamps, public assistance fraudently YOU HAVE THE RESPONSIBILITY TO REPORT IT TO THE APPROPRIATE AUTHORITY. Thar is medicare, medicaid, your public assistance office, your state attorney general. And you don't have to give your name. All you need is the name and address of the suspected person or persons. You can even send a letter in. And while you are at it, take a look at the facility you work for and their /mistakes'. It is funny how they keep making the same one over and over and over-------

Grannynurse

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I'm totally disabled and get Medicare. It's no walk in the park I will tell you hthat. The looks I get from drugstore clerks, office assistants, hospital clerks shrivel the soul. When you get SSDI you have no choice to get Medicare. If you don;'t then they treat your bill as if you have it and you are responsible for the difference plus what Medicare would have paid.

I don't qualify for Medicaid, but I'm trying to get it for care for my Mama. I can't handle her physically and she is draining me emotionally. At $900 mo SS bbefore the $88 for Medicare she makes just borderline of the Medicaid limit. I promise when we get it we will smile with happiness and not with wrath or snottiness.

Some people know how to be appreciative. SOme people only know how to ply the system. Everyone who gets Medicaid is not an ungrateful wench, please believe it.

I'm totally disabled and get Medicare. It's no walk in the park I will tell you hthat. The looks I get from drugstore clerks, office assistants, hospital clerks shrivel the soul. When you get SSDI you have no choice to get Medicare. If you don;'t then they treat your bill as if you have it and you are responsible for the difference plus what Medicare would have paid.

I don't qualify for Medicaid, but I'm trying to get it for care for my Mama. I can't handle her physically and she is draining me emotionally. At $900 mo SS bbefore the $88 for Medicare she makes just borderline of the Medicaid limit. I promise when we get it we will smile with happiness and not with wrath or snottiness.

Some people know how to be appreciative. SOme people only know how to ply the system. Everyone who gets Medicaid is not an ungrateful wench, please believe it.

I hope you qualify. I can't. Am trying hard to figure out which of the providers to choose for Medicare D. It is a mess to figure out. How about you?

Grannynurse

I

Specializes in Public Health, DEI.

So far, no one has said anything to convince me that these cases they are citing are examples of fraud. There is no way these people would be able to qualify for Medicaid if they owned these vehicles of which are being spoken, so they're either in hawk to the lien holder (and what's wrong with these lenders that they extend credit to people with such low incomes, I don't know, but that doesn't constitute fraud), or they're borrowing the cars. My Dad died several years before his time, solely because he was so opposed to the idea of applying for disability or Medicaid that he used every dime of his savings and became destitute. He would rather have died than to take money from the government. He wouldn't even tell us he didn't have money for his insulin. We had no idea. I hate to think that there is such a stigma attached to public assistance that someone else out there is going to lose a parent before their time, but apparently that is the case. The sad thing is that had he applied for this assistance, there are those of you out there who would have sneered at him and wondered why a man who looked so able bodied wasn't "contributing to the system". In reality, he contributed to the system every year of his life, but became self employed just a few years before he became ill. The Medicaid law is so complex that there is no way any lay person could understand it. I'm not even convinced that the administrators who are supposed to understand it have a good handle on all the subtleties. I have no doubt that there are cases where it is being abused, again because that's the way most every system works. I'm careful about applying that judgment to any particular individuals, though, because I have no way of knowing all the facts.

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