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.
I hope this isn't derailing the thread ... this is a discussion that really needs to happen. I just wish I could see the same level of outrage about those who are abusing the system to the tune of billions, not millions, of our tax dollars. Dishonest vendors, providers, contractors, politicians are stealing far more than free taxi vouchers and inappropriate ER visits.
I was on the welfare system for three years beginning in 1979. At that time, in my state, there was tremendous publicity about so-called "welfare queens" who were indeed ripping off the system for huge amounts of money. However, I had to back up and think again when I picked up a newspaper and actually read it. On the front page was a banner-headlined story about a woman collecting welfare in 2 states. She owned a home in Florida and was estimated to have collected several hundred thousand dollars in fraudulent benefits. Disgusting as that was ... buried on an inside page was a story about a psychiatrist who had collected $4,000,000 - yep, that's four million dollars - in phony charges to medicaid for services never provided. Think about it.
There's a tidal wave of money pouring through the health care system: public assistance money, insurance money and out-of-pocket money. Is it a surprise to anyone that there's a feeding frenzy out there? Fraudulent billing ... "up-coding"... sky-high pricing ... superfluous middle-men up the wazoo, each taking their cut of the pie ... puh-leez! Yet, the people we seem to focus on are the ones at the bottom of the heap. I think there's something wrong with this picture.
The abuses discussed in this thread are real ... when I was on welfare I got advice left and right on how to get this and that for free, how to work the system and how to scam the system (there's a difference). When it's 3AM and you have an overly-entitled scammer riding your butt for every freebie possible - threatening this and that - verbally abusing you just because s/he can - all on YOUR nickel - who wouldn't get fried? I just think there's a larger context that needs to be considered.
Specializes in icu, er, transplant, case management, ps.
The vast majority of people on Medicaid are children. I vote we treat them.
As to abuse - work in LTC for a week. See what we spend on keeping the living dead alive after their kids have had all of their stuff transferred out of their name so they don't lose their inheritances.
Interesting, since in both New York and Florida individuals and couples are not allowed to transfer or sell assessts then apply for Medicaid. There is a two year waiting period or they cannot get Medicaid. No state, that I am aware of, allows anyone to transfer their assessts to their adult children, to qualify for Medicaid. But if your state does, please list it. I would love to kmow which one it is.
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.
This post is confusing to me and I think it's because I don't know what your current profession is--I see you are a pre-nursing student. Are you working in the insurance business at the moment? Pt's on medicaid don't generally require a nurse leave the comfort of his/her home...
Also, doing clinical at a public health hospital and volunteering at a needle exchange I met plently of people who were uninsured and weren't signed up for medicaid. The system for registration can be complex, and many of these patients have numerous barriers to just getting signed on.
Are you saying that we, as American tax-payers, can't opt out of paying taxes? Alas, this is true. That is the law of the land. Taxes, when they're spent properly, pay for public services. Building schools, paying teachers, some healthcare providers, fixing dangerous roads, ensuring access to safe water, allowing our elders to live as independently as possible, and assisting people in need when circumstances make it so they are unable to help themselves.
I have never heard anyone take this view that medicaid recipients are "forcefully" taking money from other American taxpayers (because guess what? people on medicaid have to pay taxes too). Your worldview seems limited, especially since so many other countries have defined healthcare a fundamental right and turned to single-payer universal healthcare systems.
Interesting, since in both New York and Florida individuals and couples are not allowed to transfer or sell assessts then apply for Medicaid. There is a two year waiting period or they cannot get Medicaid. No state, that I am aware of, allows anyone to transfer their assessts to their adult children, to qualify for Medicaid. But if your state does, please list it. I would love to kmow which one it is.
Woody:balloons:
It's three years here. You think there are no signs prior to that?
I saw it done all the time. There are attorneys here who specialize in getting rid of the assets before nursing home time comes.
i have told my children tht i don't want any heroic measures but if i have to be admitted to a nursing home i would want my children to have my ptiiful little possessions
there should be a level such as: if you have assets more than $100,000=/- than anything over that you forfeit but to have to convert your home, small saving, jewelry that may have been handed down from grandparents that is not right when someone who never worked or saved can bounce right in with no penalties
Specializes in icu, er, transplant, case management, ps.
It's three years here. You think there are no signs prior to that?
I saw it done all the time. There are attorneys here who specialize in getting rid of the assets before nursing home time comes.
Since I went on disability, I lost just about anything of value I had. The only thing I have is some rings, including a lavender jade one, which goes to my daughter, and the rest to my granddaughters. I have a life insurance policy that is enough to bury me.
Down here, in Florida, most of the ones who have any assets, usually have enough insurance to pay their long term nursing home bills. Or they stay at home with someone they have hired to care for them. It is the middle class one's that get stuck. If they own a home, if the husband goes on Medicaid first, the wife is allowed to remain in the home until both of them die. Then the home is sold and applied to paying back the state.
i have told my children tht i don't want any heroic measures but if i have to be admitted to a nursing home i would want my children to have my ptiiful little possessions
there should be a level such as: if you have assets more than $100,000=/- than anything over that you forfeit but to have to convert your home, small saving, jewelry that may have been handed down from grandparents that is not right when someone who never worked or saved can bounce right in with no penalties
Interesting, since in both New York and Florida individuals and couples are not allowed to transfer or sell assessts then apply for Medicaid. There is a two year waiting period or they cannot get Medicaid. No state, that I am aware of, allows anyone to transfer their assessts to their adult children, to qualify for Medicaid. But if your state does, please list it. I would love to kmow which one it is.
Woody:balloons:
Federal law has basically done away with inheritance, especially since 2005 when the lookback period changed from 2 to 5 yrs.
And I'd beg to know what old person would want to keep their property to give to the government rather than their own family. You can't blame them for that.
I was sitting with a woman in private duty last week (very sharp woman) who was telling me the rehab center/nursing home where she spent two months tried to send her daughter a bill for over $5,000. I asked her were they trying to say your Medicare would not pay? and she told me they want this place (her house). Then this woman was telling me about this boy (I don't know what someone 85 y/o considers a boy) who she got to know in there who came in and actually started getting better where he could do more for himself and get around. She said she told him looks like you could be at home as good as you're doing now. She said he told her I can't go home. I don't have a home, anymore, they took it when I came here.
At least if his home had been transferred to his greedy family he might have had something to come back to.
Specializes in icu, er, transplant, case management, ps.
Like I've said, I would love to know the counties and states in which counties and/or states have either allowed assets or real estate to be transfered to relatives or seized by counties, states, or private entities for payment of bills or to escape income levels. There are laws in this country. And just like people cannot transfer real property, within a set period of time, to qualify for Medicaid, others cannot seize one's property for payment of bills without first going thru lengthy legal procedures, unless the individual voluntarily turns over assets to an individual in lieu of payment.
Here in Florida, a couple can have less then $2500 assets and own a home, can and do qualify for Medicaid. The one major difference is the state can place a lien on their home. And when both a finally dead, the home must be sold to satisfy the state's lien. And given what LTC facilities charge, even state Medicaid, even today, the money is gone before the children can collect anything.
Anyone can file a lien. It getting granted is an entirely different story. And an individual having any assets worth seizing is also another story. I hmmm 'owe' a LTC facility more then $3,000 for a readmission last August. The only insurance I have is Medicare. I have no real assets. I did have a car with over 240,000 miles on it but it has since died. I applied for and was turned down for Medicaid. My monthly income was deemed to much. Funny, the LTC facility suddenly found me capable of being discharged to live on my own. They are still waiting for their money.
My dad was admitted to a LTC facility and Georgia was applied to for Medicaid. Unfortunately, they took a long time in reviewing my dad's application and then denied it. The LTC facility tired to bill my brother, then me. I told them where they could go and told my brother to tell them the same thing. They admitted him based on his application to Medicaid. They can't bill me or my brothers. They might have made a case for a lien b put they decided against that.
You see, I have both worked in the industry, worked with state Medicaid agencies, know the past and current regulations and like I have posted, would love to know where all these alleged incidents take place. Funny, no one every post that information. Just like no one ever post of those individuals who cheat Medicaid, that they seem to know and fail to report, as to just what county and state these incidents occur in.
I'm sorry but I have to take issue with some of what you have posted. To be honest, I am kind of tired of hearing about all the illegals that are collecting social benefits in your state. If they are, they are doing it illegally. To collect welfare, medicaid, food stamps, you have to be a registered legal alien or a citizen. You can get emergency treatment but that is it.
And while you apparently agree I have earned my SSDI, there are others out there that feel I have not. They resent the fact that I have a computer, that I have access to the net. They feel I am stealing their money right out of their pockets because I can spend time sitting, surfing the net. Somehow they reason this means I should be able to work. Kind of silly, isn't it.
Woody:balloons:
First paragraph: yes, they are doing it illegally. Illegals tend to do that, because they cannot do it legally. And they will keep on doing it because we cannot turn them in for doing so.......there is a fear that illegals will then not seek medical care when it's really necessary for fear of being deported.
Second paragraph: yes, I know many people think the opposite of what I said, they tend to lump all SSDI recipients in the same mold. I don't. I was trying to support you in spite of our differences of opinions. I don't know what I've said to irk you so bad in the past, but it seems that once again all I managed to do was irritate you. I think it's best if I just stay out of your posts from now on.
heron, ASN, RN
4,662 Posts
I hope this isn't derailing the thread ... this is a discussion that really needs to happen. I just wish I could see the same level of outrage about those who are abusing the system to the tune of billions, not millions, of our tax dollars. Dishonest vendors, providers, contractors, politicians are stealing far more than free taxi vouchers and inappropriate ER visits.
I was on the welfare system for three years beginning in 1979. At that time, in my state, there was tremendous publicity about so-called "welfare queens" who were indeed ripping off the system for huge amounts of money. However, I had to back up and think again when I picked up a newspaper and actually read it. On the front page was a banner-headlined story about a woman collecting welfare in 2 states. She owned a home in Florida and was estimated to have collected several hundred thousand dollars in fraudulent benefits. Disgusting as that was ... buried on an inside page was a story about a psychiatrist who had collected $4,000,000 - yep, that's four million dollars - in phony charges to medicaid for services never provided. Think about it.
There's a tidal wave of money pouring through the health care system: public assistance money, insurance money and out-of-pocket money. Is it a surprise to anyone that there's a feeding frenzy out there? Fraudulent billing ... "up-coding"... sky-high pricing ... superfluous middle-men up the wazoo, each taking their cut of the pie ... puh-leez! Yet, the people we seem to focus on are the ones at the bottom of the heap. I think there's something wrong with this picture.
The abuses discussed in this thread are real ... when I was on welfare I got advice left and right on how to get this and that for free, how to work the system and how to scam the system (there's a difference). When it's 3AM and you have an overly-entitled scammer riding your butt for every freebie possible - threatening this and that - verbally abusing you just because s/he can - all on YOUR nickel - who wouldn't get fried? I just think there's a larger context that needs to be considered.