new case manager

[snngregory]

I wanted to know if anyone has any useful information about case management especially in the ER and applying for emergency medicaid. What do you do about patients who do not have insurance but do not qualify for medicare or medicaid?

[nurseprnRN, BSN, RN]

You help them get insurance through the state or federal health insurance exchange... the social worker will do that.

[Paul B]

Oftentimes, ER patients do not have insurance - this is why they come into the ER in the first place. The most important aspect of ER case management is to determine if the patient actually needs hospitalization or a referral to community services. A good ER Case Manager is a wealth of information about their specific community and who or what is available. It is also important to remember that some ER patients are drug seeking and one must have excellent skills and team communication to identify who needs help and who needs boundaries. This is one of the most comprehensive CM jobs around. Be sure to maintain a team approach - and include the physicians in all discussion of psycho-social issues.

[SummerGarden, BSN, MSN, RN]

OP: There are emergency funds that support patient with no insurance and show up to your emergency room. You can discuss this further with your financial/billing staff, your department heads, and/or the ED heads. In some cases the funds are federal given to a state and in other cases they are in the form of charitable grants supported by an attached foundation or local charity.

However, and sadly, if you live in a state that did not expand or accept additional Medicaid dollars (refused to participate in the Affordable Care Act/Obama Care), then your people may tell you that there is no money or the hospital has run out of the federal funds. If that is the case, your hospital is in for a world of hurt, barring that your charitable foundation (assuming you have one) is not wealthy. In fact, research the many hospitals around the South (check out Georgia, for example) that have closed! More are to come!

Federal law protects all patients (citizens or not) that enter an ED seeking evaluation despite an inability to pay. So more hospital closures in the states that refused to expand for political GOP (Crazy Tea-Party led)/anti-Obama reasons, will be closing turning their state's health care system into one that mirrors a third world country!

But I digress, as GrnTea has mentioned, get a social worker involved no matter your circumstances if you can. An experienced one will know of the hospital and local community resources. You can gain the knowledge you need to proceed in the future. Good luck. :)

BTW, I live in a state that is not led by the Tea Party and the Republicans that live here are somewhat reasonable and so we accepted the ACA/Obama Care Medicaid expansion. Anyway, those who do not qualify for Medicaid traditionally, but also do not have health insurance, are being covered under the ACA (the prime reason for it's existance). And so, to answer your question in a hopeful way, as an ED CM I assist my patients with signing up for insurance through my state's exchange. However, my understanding is even in states that did not accpet the expansion, patients still have options ... Although the options are not as good or comprehensive, check out the information on federal government's website to better assist your patients:

healthcare.gov