Patients on Medicaid

Nurses Relations

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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.

We have an NHS here (Australia) and while it's not perfect I am very glad we have it. I can walk into any hospital in Aus and be treated with respect, dignity and not have to go home and face a huge bill. Reading this thread makes me very glad I live where I live.

I was watching a movie/show thing last night about a fellow and his girlfriend who lived on minimum wage in the US for a month. Gave me pause to think when I saw them work so hard and only bring home 30 or 40 dollars a day. She got sick with a UTI and got a bill for about three hundred dollars then he hurt his wrist and got a bill for about four or five hundred dollars. Forty dollars for an ACE(?) bandage. Not the kind of life I would want to lead. Maybe people just get so depressed having to fight for every little thing they get that it puts them over the edge?

Specializes in IM/Critical Care/Cardiology.
I've never had WIC but I've learned just by standing behind them in line at the store (and having to wait 30 minutes so they could redo their items) that no, you don't get the giant boxes of cereal and the super large cartons of juices.

Never knew about their attitudes, but they need to learn how to read the fine print.

I have no intention of being rude here,

but maybe they never HAD to be on Medicaid and find it confusing, coming from a "nl" life and now there are so many rules.

Or maybe they are embarassed that a situation has changed their life so much, it's a wonder to them how they even entered a store or a hospital knowing there is a stigma about Medicaid and they are depressed about it and don't know how to play the game because something horrible has happened to put them there and to have no other choice except Medicaid as their last resort..:twocents:

I hear you Leslie.:redpinkhe

Why because she stood up for rights, when the store manager unjustly told her that she couldnt use the coupons for her childs wishes. That is sad.

Umm, Tom, the lady hit the manager with a glass juice bottle. You may call that 'standing up for her rights', I call it 'throwing a tantrum because she didn't get her way'.

The manager doesn't MAKE the rules - he just had to enforce them for everyone who wants to change them to suit themselves.

Specializes in IM/Critical Care/Cardiology.
Here is my experience with medicaid pts.

Yes, some of them can be rude and obnoxious--I agree. But remember that medicaid is a program for unemployed or low income people (or supposed to be, but that is another story). Some people who are unemployed or low income are that way because they have some sort of mental illness. Remember dumping all the mental health pts. out of institutions in the 70's? Well, now they and anyone else with a personality disorder, are all trying to cope with the rules of society. And do they get their mental illness treated and take their medications as they are supposed to? Are you kidding? These are the people who will never be employable and end up on medicaid. Do you think the person who is rude and obnoxious to you as a nurse is going to get a job in a bank and work with the public?

Remember, the people who are the most difficult to get along with are usually mentally ill...be glad you are not.

Sorry, but not all people on medicaid are mentally ill. How Many soldiers come back after risking their lives and end up with medicaid, or someone who has been misdiagnosed and due to complications cant' work......think outside of the box IMO

Specializes in Telemetry.

Its no one's business but billing's how a pt's care is being paid for. As nurses you shouldn't even be looking at their insurance info. Shame on you. :angryfire

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

And, BTW, its no one's business but billing's how a pt's care is being paid for. As nurses you shouldn't even be looking at their insurance info. Shame on you. :angryfire

As a nurse I need to know who has insurance or not in order to plan discharge. For example, do I need to set them up with a free Lovenox program, or should I call the doc and see if an ASA a day will do, do I need to find them a free walker somewhere, do they need help with their prescriptions, do they have insurance to go to rehab or do I need to get the family more involved because they are going to be taking care of the patient at home without home health or a short stay at rehab.

Working for a not-for-profit has made me an advocate for equal care, and how I take care of you isn't based on your insurance information, but in the end it does matter whether or not you have benefits in our health care environment.

Specializes in Telemetry.
I think the thread is fine. All opinions should be respected and are valid, although it's so easy to pass judgement when they are different than ours.

As a nurse I need to know who has insurance or not in order to plan discharge. For example, do I need to set them up with a free Lovenox program, do I need to find them a free walker somewhere, do they need help with their prescriptions, do they have insurance to go to rehab or do I need to get the family more involved because they are going to be taking care of the patient at home without home health or a short stay at rehab.

Working for a not-for-profit has made me an advocate for equal care, and how I take care of you isn't based on your insurance information, but in the end it does matter whether or not you have benefits in our health care environment.

In that case I see your point.

I also edited my first comment, as it was my knee jerk reaction to some of the posts I read- and I didn't read the entire thread. Like you said, everyone is entitled to their own opinion.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
In that case I see your point.

I also edited my first comment, as it was my knee jerk reaction to some of the posts I read- and I didn't read the entire thread. Like you said, everyone is entitled to their own opinion.

Thanks for the open mind. :)

I edited my response as well.

Specializes in icu, er, transplant, case management, ps.

I have been a liberal Democrat, since I was 12 years old. I do not apologize for my liberal views. I only ask, that if you want me to respect your views, please respect mine. Please respect that mine are grounded, not only in liberal feelings, but facts. And like many others, I paid taxes, as a matter of fact, I continue to pay on an old tax bill that the IRS has decided I still owe. I lived my young life overseas, in other countries, on the economy. I've also lived in different parts of our country and at different ecomonic levels. When I worked, I treated all my patients the same. It didn't matter who paid their bill, them and insurance company or the tax payers or no one. Everyone is entitled to their own opinion. And I have found, living in other countries, even those with national health insurance, have their people who moan and groan about paying taxes to pay for people they don't feel deserve their benefits. It makes no difference where you live, there will always be those that complain.

Woody:balloons:

Specializes in Community, OB, Nursery.

In my state, Medicaid doesn't pay for circumcision. (I'm glad, but that's another debate for another thread.) So, when I'm in charge in the nursery, part of my job is witnessing moms sign consents for babies' circumcisions.

I have to ask whether they have private insurance or Medicaid, and I always feel bad doing so. I tell them that it's doesn't matter to me, but there is a difference in paperwork depending on which you have. If they have Medicaid, there is a form our hospital has moms sign stating they understand Medicaid doesn't cover circs, what the cost is out-of-pocket, and that they understand they'll receive a bill for it.

So sometimes there is a legitimate reason to need to know someone's insurance status, but it's not because we necessarily care one way or the other. I'm not for people abusing the system, but I do have compassion on those who are truly trying and finding out that sometimes working hard isn't enough.

Specializes in ER/EHR Trainer.
In my state, Medicaid doesn't pay for circumcision.

And this is my point about healthcare in this country.

Correct me if I am wrong, but I was under the impression that circumcision was considered ultimately healthier for a man. If so, why would we withhold that future health from a child?

I was also thinking about others on medicaid: orphans, foster children, disabled people, and I am sure many others who had no choices in their lives. Why wouldn't we give others the same opportunity for health, that we all should have. That's why I'd like to see national healthcare-education, maintenance, check ups, and simple procedures known to increase health...made available to all.

If you are in NJ today VOTE!

Maisy;)

Specializes in Med/Surg, Home Health.

Well, my beef with some medicaid patients is that they RUN to the ER with every little quirk. Now, I was on Medicaid at one point in my life and I appreciated every time I needed it, but I did NOT take advantage of it at all. The ER is not a physicians office, its for emergencies. Ive seen some go into the ER with a sore throat they have had for 5 days. Why didnt they make a doctors appointment like everyone else does.....because they dont have to pay the additional high cost of an ER visit, and its convenient. I had one man get mad and slam the IV machine to the floor and busted it (he was ETOH detox)...his response was...my insurance paid for it so its mine. He was on medicaid. I calmly responded that it paid for his USE OF IT, not to GIVE IT TO HIM and not to bust. It bothered me that he lays at home drunk, then gets a free stay in the hospital with phenobarb, ativan, etc. While he lays drunk, Im working. And my tax dollars pay for this. My dad is now at an old age...past retirement. He has worked all his life and paid taxes and health insurance. Now he has applied for Medicare, and he has to pay full price for it as if it were health insurance. But had he never worked, he would get it for free. My mother is unable to work due to major health issues (she also has worked all her life and paid taxes) and there is no help for her either. She cant afford her medications and was turned down for any assistance. My cousin draws a check and makes more money than I do as a nurse. He claims his back is messed up. He gets pain medications and SELLS THEM rather than takes it. Ive seen him lift a 4 wheeler into a truck, but yet he cant work and gets medicaid. Its people like THAT who make it hard on those who actually need assistance. The system is backwards. Its sad for the ones who have to pay out the orifice for health insurance and medical attention, because they usually cant afford to go.

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