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.

[sarahdeez, BSN, RN]

I certainly hope that if tragedy ever struck you and/or your family, causing you all to need the benefits of welfare and Medicaid, that you will be as gracious as you expect everyone else to be.

I found your whole post to be extremely snotty and offensive. I hope I'm never unfortunate enough to be one of your patients; who knows what you'd find to judge about me.

These are harsh words for someone so acusatory about judegment.

[FireStarterRN, BSN, RN]

This whole thread seems to be spiraling downwards.

[sarahdeez, BSN, 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:

While I have never been in poverty myself, I have lived amongst it most of my life. You may find it hard to believe but I could give you a long list of people to support that accusation. I will also like to add that for people who have children to get money for them, it is also to their benefit to have their child declared as a special eduction child. This increases the amount of money they receive per child. In the school system there are administrators who receive requests to have children tested and retested to try to have them put into the special education program - just for the additional money. Parents will tell their child they "better miss every question on that test." This puts the child in a position where they will be unable to receive a high school diploma (only a certificate of attendance). So they will likely continue the cycle when they become adults.

And yes some of them do work under the table. For this I blame the people who hire them because they should be withholding and reporting their tax withholdings to the IRS.

But, yes, I do honestly think that... and I have seen it - numerous times, over decades.

[Multicollinearity, BSN, RN]

If anyone doubts whether medicaid is insurance or not, just call your state's Department of Insurance (or Insurance Commissioner in some states) and ask if they can help you with trouble you are having with medicaid. Insurance is regulated by each state. They will quickly tell you that medicaid is not insurance.

[GrnHonu99, RN]

While I have never been in poverty myself, I have lived amongst it most of my life. You may find it hard to believe but I could give you a long list of people to support that accusation. I will also like to add that for people who have children to get money for them, it is also to their benefit to have their child declared as a special eduction child. This increases the amount of money they receive per child. In the school system there are administrators who receive requests to have children tested and retested to try to have them put into the special education program - just for the additional money. Parents will tell their child they "better miss every question on that test." This puts the child in a position where they will be unable to receive a high school diploma (only a certificate of attendance). So they will likely continue the cycle when they become adults.

And yes some of them do work under the table. For this I blame the people who hire them because they should be withholding and reporting their tax withholdings to the IRS.

But, yes, I do honestly think that... and I have seen it - numerous times, over decades.

Wow..shocked...I have never heard of this!

[redhotzzz]

IF anyone had ever told me that one day I would be ON MEDICAID, I would have called them a LIAR and said that as a RN, it just won't happen! BUT, my retina detached 30 days into a new ER job and I had to wait another 30 days til my health insurance kicked in. I knew from being and ER RN that what I was seeing was BAD...and talked to one of the midnight ERPs who I knew from 20 yrs ago at another ER. Someone there overheard our conversation and when my Mgr came to work in the morning she called me to come to work early and they told me surgery for detached retinas was often expensive and numerous and since I'd only been there less than 90 days they were going to severe their ties with me to save their insurance premiums. Don't say it's not legal, IN NC it's at 'at will state' and they can do any thing they want to. I drove home to my eye doc and he did a free eye exam and sent me to a retina specialist immediately on Monday (this all happened at 3pm on a Friday). The ONLY reason I even got Medicaid, was one of my son's counselors at high school is a friend and neighbor and she told me to go to DSS and tell them what happened. I refused and she came and got me in the car and took me there. I still owe her for doing it.....as I have had a total of 21 surgeries since April 2006....not all on my eye. IF I had had insurance I could not have paid all those copays and would have been left with so many medical bills I'd never see daylight for the rest of my career. Now I seek employment and because I am blind in one eye and am not sure IF I can start IVs one-eyed I hesitate to take an ER job. I have always been the one that others come to for difficult sticks. Anyway, you just NEVER can say NEVER, because I just don't believe to this day that I have Medicaid....and Food Stamps....what a joke those are! Try to feed a teen boy of 15yrs who is 6'4" and 191lbs. on a mere $200 a month. Food stamps dont' buy shamooo, deodorant, laundry soap, body soap or toilet paper ETC. Teens don't understand! How has my son handled going from affluent to poverty??? He took an overdose of all his allergy meds for New Years....thinking I was going to die and leave him. It was just after I fell and broke my leg and arm and my optic nerve is damaged beyond repair. We had no Thanksgiving, No Christmas but we do still have one another. I got him some great help and he's doing better now, but you just NEVER KNOW.....NEXT WEEK COULD BE YOUR TURN!

[Multicollinearity, BSN, RN]

IF anyone had ever told me that one day I would be ON MEDICAID, I would have called them a LIAR and said that as a RN, it just won't happen! BUT, my retina detached 30 days into a new ER job and I had to wait another 30 days til my health insurance kicked in. I knew from being and ER RN that what I was seeing was BAD...and talked to one of the midnight ERPs who I knew from 20 yrs ago at another ER. Someone there overheard our conversation and when my Mgr came to work in the morning she called me to come to work early and they told me surgery for detached retinas was often expensive and numerous and since I'd only been there less than 90 days they were going to severe their ties with me to save their insurance premiums. Don't say it's not legal, IN NC it's at 'at will state' and they can do any thing they want to. I drove home to my eye doc and he did a free eye exam and sent me to a retina specialist immediately on Monday (this all happened at 3pm on a Friday). The ONLY reason I even got Medicaid, was one of my son's counselors at high school is a friend and neighbor and she told me to go to DSS and tell them what happened. I refused and she came and got me in the car and took me there. I still owe her for doing it.....as I have had a total of 21 surgeries since April 2006....not all on my eye. IF I had had insurance I could not have paid all those copays and would have been left with so many medical bills I'd never see daylight for the rest of my career. Now I seek employment and because I am blind in one eye and am not sure IF I can start IVs one-eyed I hesitate to take an ER job. I have always been the one that others come to for difficult sticks. Anyway, you just NEVER can say NEVER, because I just don't believe to this day that I have Medicaid....and Food Stamps....what a joke those are! Try to feed a teen boy of 15yrs who is 6'4" and 191lbs. on a mere $200 a month. Food stamps dont' buy shamooo, deodorant, laundry soap, body soap or toilet paper ETC. Teens don't understand! How has my son handled going from affluent to poverty??? He took an overdose of all his allergy meds for New Years....thinking I was going to die and leave him. It was just after I fell and broke my leg and arm and my optic nerve is damaged beyond repair. We had no Thanksgiving, No Christmas but we do still have one another. I got him some great help and he's doing better now, but you just NEVER KNOW.....NEXT WEEK COULD BE YOUR TURN!

This kind of thing could happen to anyone. I've heard numerous stories like this over the years.

Another seldom-discussed issue with health insurance and employment is how smaller employers often shun hiring those over 50 because they can't take the rise in their health insurance premiums that the typical over 50 employees are likely to bring.

[CHATSDALE]

for rehab and red hot all i do is give hugs and hopes for a better day

for those that need government services i am so glad that they are available

inf..that doc that worked in sweden i am unable to understand..i have known many women who had babies after going to subsidized md/private hospital..or a public clinic/charity hospital: there is no reason why a baby should not receive the care prenatal-postnatal

the services are out there if the mother would avail themselves of them

about the children who are made to appear 'special needs' in order to collect more money [they can quailfy for ssi plus extra state benefits]

a woman that i know all her kids were on this program and had to be in special education in school..when she lost custody of the youngest child and he went to mississippi to live with his dad his grades shot up

his speech is so much improved,

[EmmaG, RN]

These are harsh words for someone so acusatory about judegment.

Now this is ironic...

[Susan9608]

Now this is ironic...

:) I kinda thought so too.

[woody62, RN]

I need to defend a few things I have posted since some have taken great issue with my postings. I have been in the health care field since 1964. In 1965 Medicare/Medicaid came into being. Both programs were viewed by the medical profession as socialized medicine and many refused to accept patients with either. Over the years, things changed and some physicians and hospitals made money hand over fist, a great deal of it not legally. And I know because I investigated, for NYS, for two years such doctors and hospitals

Over the years I have listened to others, including my own family members, claiming that welfare recipients have more children to collect more money. Sorry but the cost of raising a child verses collecting more money from welfare does even come any where close to the cost of raising a child. Someone post that a mother receives a tad bit more then $200 for each new child. They failed to say if this was a month or a year. I know in Florida and New York State pay, on average, approximately $100 for each new child. I only had one child and I couldn't have supported her on $100. And that $100 was not a month, it was a year. That works out to less then $8 a month. I worked extra shifts to pay for my own education, to pay for my daughter's preschool, to buy her clothes, to give my parents some money toward her food. And I did this while going to school full time. I am not bragging, I am only reporting how much I had to work to support my one daughter.

And when I went to the Schenectady city welfare office to see about obtaining welfare and Medicaid, explaining I was told I couldn't work as many hours because of a health problem I had developed, I was told, sorry you are a LPN. You can quit school and work full time. We will not even consider you. Fortunately, my program director was able to obtain several grants that helped me pay my bills for my last semester. I certainly didn't rage on and on about welfare cheats because I didn't know any.

My experiences, with the system were all back in the late 60s, early 70s. I didn't come any where near to qualifying for Medicaid until the 18 months it took me to qualify for SSDI, in 1990. And as soon as I did, I lost my Medicaid. And I didn't qualify for Medicare for another six months. I half my dose of necessary medications to make them last longer and prayed I wouldn't get sick enough to have to go to the ER or be admitted to the hospital. But again, I didn't see anyone cheating off of welfare or Medicaid.

I have worked in New York City, in some of the worse, violent neighborhoods. And again, I didn't see any big TVs in the apartments I went into in the projects. I guess my patients hide them so I wouldn't see them. And when I went over diets, checking their cupboards and frigs, I didn't see any expensive cuts of meat. I guess they hide them away as well. And clothes. I remember when the mothers would get their clothing check for the school year. Out of which they had to buy everything, including heavy winter clothing. None of my patients wore designer anything. And when I worked in Workers Comp, here in Florida, for nine years, all I saw were poor people, living on the edge.

I am not saying that there are not cheaters. If anyone knows about anyone else cheating the system, it is their responsibility to turn them into the appropriate people. If I found any of my clients cheating the Workers Comp system, I turned them into their insurance companies. And I've testified at their trials. Just like I turned in doctors who I found cheating Medicaid and Workers Comp, or writing unnecessary narcotic prescriptions. I believe that anyone who needs help should get it. But anyone who cheats any system, you don't want me to find out. I will be your worse enemy. I even turned in two administrator for HCA, to the FBI, for false billings to my Medicare coverage. And both were found guilty.

There is one more thing I would like to post. When someone applies to their state for assistance, they frequently are told half truths or out right lies. State employees do this to discourage people from applying. Unfortunately for them, more and more people are becoming net savvy, capable of looking up their state's laws and regulations.

Woody:balloons:

[Shaggyb2000]

Apparently, those who call my comments snotty or think that I was saying that medicaid patients are stupid and don't deserve the same caring attitude from their nurse totally missed what I was saying. Medicaid patients should be more gracious and kind BECAUSE they are forcefully taking money from anyone who pays medicaid taxes. Medicaid is not insurance due to the fact that a person doesn't have the right to opt out. If anyone decides they would rather pay for something else besides their private insurance they can. Try that with medicaid and you will go to jail. Healthcare isn't a right if someone else has to provide it against their will. So, I expect them to be gracious, no matter what circumstance happened to put them in the position that they use medicaid, because I have to take more time away from my wife and family to provide insurance for people who can't or won't make the sacrifice or do what is needed to provide it for themselves. Time equals life and you have to spend time working to provide for yourself and family. So if I have to spend more time working to pay for medicaid for people I don't know then that is time and life I don't get to spend with my wife and family.