Patients on Medicaid

[DiEd]

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.

[erroridiot]

when i think back on some of the nastiest, very most rude and horrifying treatment i have endured from patients over the years, about 90% were from the wealthy side of the tracks - and i do mean horrifying treatment

[leslie :-D]

when i think back on some of the nastiest, very most rude and horrifying treatment i have endured from patients over the years, about 90% were from the wealthy side of the tracks - and i do mean horrifying treatment

you know, i'm 49 yrs old, have been around the block and have seen a lot in my life.

i live/work in an urban area and deal with people of all backgrounds.

as a nurse, i've been treated poorly by many.

but it just never occurred to me, to correlate behaviors to social status.

in spite of my worldly sophistication, i am now feeling quite green.

how can one's nasty attitude be equated with being rich or poor?

it just doesn't make sense.

i've met those on public assistance, who could act angry and entitled.

yet i could say the exact same thing about those who are upper class.

similarly, i've met very grateful, polite pts/families, from all classes.

i can say with certainty, there is no accurate stereotype.

people are people, with or w/o a medicaid card.

if one feels embittered, let it be r/t who these people are, and not where they come from.

leslie

[redhotzzz]

The amount in NC is $236 per child, to those who grew up into the system and who are selling their food stamps to buy incidentals, that is a lot of money! It's another $236 they can sell their food stamps for and spend on whatever they want to.

[woody62, RN]

Do you honestly think that poor mothers have more children in order to collect an additional $236? As usual, this is what I have heard, only to often, by those that have never lived on a poverty level income. Believe me, even with food stamps, section eight housing, Medicaid, and welfare payments, no one makes a living when collecting these items. And if they do, they are generally working under the table or receiving money from some other unreported income, both of which is illegal. And both of which should be reported to appropriate authorities for investigation. Of course it is easier to make unsupported accusations, isn't it.

Woody:balloons:

[GeminiTwinRN, BSN]

Clients who come in on medicaid should absolutely be more gracious than those who are not on medicaid. They have no idea what procedures cost, or the actual cost of their meds. When the welfare recipients hit their limit for the month on their coverage for drugs, which is usually a combination of hydrocodone and Xanax, they suddenly don't need it as bad and can somehow wait. The difference between someone who buys their own insurance and ones on welfare are total dependence. If everyone decided to quit working, private payers would still get coverage and the medicaid patients would not. That is why good attitudes from them shouldn't be expected but demanded.

I would like to point out to you that medicaid is, in fact, insurance. It may not be private health insurance, but it is insurance. We as providers of services (especially as NURSES!) have no business having a holier than thou attitude towards anyone with or without insurance. At least these people (of whom I was one at one time, when I was in need) have insurance. There are millions of UNinsured people who we provide service to, and we also provide that service willingly.

What in the world gives you the idea that folks who have medicaid insurance have no business having an less than "good attitude"? The fact is, that people are people, no matter whether they have medicaid or Humana, or no insurance at all.

I can tell you that I am far too busy in my practice as an RN to even glance at a chart to see whether my pt has insurance or not, and wouldn't even dream of doing so unless I were involved in their discharge planning to ascertain coverage of home health visits or prescription coverage.

I cringed when I read your post.

I was "on the dole" for a period of almost 3 years. I was not an abuser of prescriptions or the "system", nor was I a person who had a bad attitude. I was persuing my career as an RN, and was going through rough financial times. I needed the coverage for my young son, and I am forever grateful that I was able to receive the coverage. Now, I am paying for my group health insurance through my employer. Government assistance enabled me to get my education, and get out a financial hellhole. I can never say enough about how much I appreciate having had medicaid to cover myself and young son during my time of need.

I hope you never have such a time. I hope you are always well, and always have affordable health care coverage available to you and your entire family. However, if you happen to have some human compassion, I beseech you to re-think what you've posted here and avoid making such harsh judgments about a population of people who you seem to have such little regard for.

[Multicollinearity, BSN, RN]

As much as I am reticent to point this out, I have to. Legally, medicaid is not insurance. Insurance is a contract between a policyholder and a licensed private insurance company, insurance corporation, or non-profit insurance organization to indemnify against an unknown risk. Insurance is a legal contract to pay future claims in exchange for premiums.

Medicaid (and Medicare) are health care financing methods provided by the government.

All of this said, I do agree with the intended spirit of the above post. At least those on medicaid have made arrangements and aren't showing up at hospitals with no ability to get the hospital paid.

[GeminiTwinRN, BSN]

as much as i am reticent to point this out, i have to. legally, medicaid is not insurance. insurance is a contract between a policyholder and a licensed private insurance company, insurance corporation, or non-profit insurance organization to indemnify against an unknown risk. insurance is a legal contract to pay future claims in exchange for premiums.

medicaid (and medicare) are health care financing methods provided by the government.

all of this said, i do agree with the intended spirit of the above post. at least those on medicaid have made arrangements and aren't showing up at hospitals with no ability to get the hospital paid.

medicaid is a joint federal-state program that provides health insurance coverage to low-income children, parents, seniors and people with disabilities. while congress and the centers for medicare and medicaid services set out the main rules under which medicaid operates, each state runs its own program. as a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

both the federal government and state governments have made changes to the eligibility requirements and restrictions over the years. this has most recently occurred with the passage of the deficit reduction act (dra) of 2005 (pub.l. no. 109-171) which significantly changed rules governing the treatment of asset transfers and homes of nursing home residents.[3] the implementation of these changes will proceed state-by-state over the next few years. to be certain of your rights under the act you should consult an expert, as the rules are complex. the dra now requires that anyone seeking medicaid must produce documents to prove that he or she is a united states citizen or resident alien.

[Multicollinearity, BSN, RN]

medicaid is a joint federal-state program that provides health insurance coverage to low-income children, parents, seniors and people with disabilities. while congress and the centers for medicare and medicaid services set out the main rules under which medicaid operates, each state runs its own program. as a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

both the federal government and state governments have made changes to the eligibility requirements and restrictions over the years. this has most recently occurred with the passage of the deficit reduction act (dra) of 2005 (pub.l. no. 109-171) which significantly changed rules governing the treatment of asset transfers and homes of nursing home residents.[3] the implementation of these changes will proceed state-by-state over the next few years. to be certain of your rights under the act you should consult an expert, as the rules are complex. the dra now requires that anyone seeking medicaid must produce documents to prove that he or she is a united states citizen or resident alien.

i agree with your sentiment and motivation. the terminology is a pet peeve of mine. there is a big difference between a legal insurance contract and government assistance programs.

legally, medicaid and medicare are not insurance.

legal definition of insurance:

http://dictionary.law.com/default2.asp?selected=990&bold=insurance||

insurance:

http://dictionary.reference.com/browse/insurance

the terminology has been so misused that it seems even those who should know better refer to governmental healthcare financing and assistance as "health insurance." case in point, the program called schip (states children's health insurance program). insurance, it is not. the correct definition is used in the body of the bill. some politician must have named the bill that was passed so the masses could understand it. it seems incorrect terminology is used rampantly. maybe it is so because the masses understand what is probably meant when someone says "health insurance" even though often it is not health insurance that is being referred to. legally, insurance requires payment of a premium between a policy holder and licensed insurance company.

most government medicaid and medicare documents use the correct terminology which is healthcare financing, entitlement programs, and medical assistance.

but i do understand why this may sound odd, at first.

from hhs:

http://www.cms.hhs.gov/medicaidgeninfo/03_technicalsummary.asp#topofpage

"title xix of the social security act is a federal/state entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. this program, known as medicaid, became law in 1965 as a cooperative venture jointly funded by the federal and state governments (including the district of columbia and the territories) to assist states in furnishing medical assistance to eligible needy persons. medicaid is the largest source of funding for medical and health-related services for america's poorest people."

this may sound like splitting hairs, but i tell you it is not. insurance companies are licensed and regulated by each states' insurance department. medicaid and medicare are not licensed and regulated the states' insurance regulatory agencies. it is almost like saying, "but a cna is a nurse because a cna provides nursing care." well no. not according to the legal definitions and governmental regulatory bodies. but to the public, all the helpers in scrubs are "nurses." it is similar with medicaid being called "health insurance." medicaid provides healthcare funding, but it is not insurance. just as a cna provides care, but is not a nurse.

whew! like i said, i do agree with your sentiment, though.

[island40]

I don't understand why Medicaid is not insurance, I paid a premium when I was on it in Iowa. $65 a month. My son paid $10 a month for Iowa's version for children- HAWK-i. It worked just like private insurance, got a card, made claims and some were paid, some were not, some had deductables.... sounds like insurance run by the state under guidlines set up by the feds just like private insurance run by a private company underguidlines set up by the state and fed governments regulating the insurance inductry.

[redhotzzz]

I beg your pardon, Woody, but WHAT makes you think that I am making unsupported accusations??? I can't wait to hear your reply!

hotzz

[Multicollinearity, BSN, RN]

I don't understand why Medicaid is not insurance, I paid a premium when I was on it in Iowa. $65 a month. My son paid $10 a month for Iowa's version for children- HAWK-i. It worked just like private insurance, got a card, made claims and some were paid, some were not, some had deductables.... sounds like insurance run by the state under guidlines set up by the feds just like private insurance run by a private company underguidlines set up by the state and fed governments regulating the insurance inductry.

The state permitted you to be covered by paying the government a small portion of the expense of the government program. Paying a small portion ($65) to a government agency does not equate to a premium. It was not insurance because medicaid is not a licensed insurance company, there was no policy (legal insurance contract), and the small payment was legally not an actual premium, etc.

I can definitely see why it appeared to be insurance to you, though.

[GrnHonu99, RN]

Do you honestly think that poor mothers have more children in order to collect an additional $236? As usual, this is what I have heard, only to often, by those that have never lived on a poverty level income. Believe me, even with food stamps, section eight housing, Medicaid, and welfare payments, no one makes a living when collecting these items. And if they do, they are generally working under the table or receiving money from some other unreported income, both of which is illegal. And both of which should be reported to appropriate authorities for investigation. Of course it is easier to make unsupported accusations, isn't it.

Woody:balloons:

I know some that have and have admitted it to me. Whether or not these individs. had something else going on under the table..who knows.

I have been on both sides of the track. Yes, I get angry when I hear people (not all) say things like: I don't care i'm on Medicaid. Yes, it makes me angry when I think of all the money I pay for insurance and still have to pay on top of my premiums...However, when I was using Medicaid..I knew how lucky I was as I had lived many years with NO insurance and trust me its awful!. I also remembered fighting the stereotypes with Medicaid. I know where the OP is coming from..I, too, have taken care of many pts (medicaid or not) that possess that sense of entitlement...its frustrating...

Bottom line: stereotypes don't work. Not everyone is one way. there are people that abuse the system but there are those that do not. Can;t let a few bad apples ruin the bunch. However, if I did have a medicaid pt. look me in the eye with that attitude and say.."I don't carehow much it costs, i have medicaid"....yep that would make me mad!