Patients on Medicaid

Nurses Relations

Published

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.

Specializes in ITU/Emergency.
I'd do the same thing I do now. My own insurance pays for both PCP visits and ER visits and PCP visits require advance planning, sometimes requiring several days notice, while the ER will see me at my "convenience" for free/small co-pay. When I feel it's warranted, you bet I go to the ER. I have gone to the ER for something as simple as strep throat just because I didn't want to suffer through the weekend with it when my doctor's office was closed. I also went for vomiting and diarrhea on Christmas day because my doctor's office was closed. I don't see how that's any different from what these people on Medicaid do ...

Generally, I've spent a lot longer than 90 minutes waiting to be seen in the ER.

What I think you're failing to see is that someday it could be YOU on medicaid - YOU could be the one needing assistance someday. When/if it happens, I sure hope the fall from grace is swift and painless from the high horse you're sitting on.

indifferent.gifbanghead.gif

With all due respect a strep throat and D&V (unless you have comorbidities) are not emergencies and there is definitely a problem with the system if people are being encouraged to go to the ER, instead of their PCP (which would be more appropriate) whether they are on medicaid or not.

Specializes in Community, OB, Nursery.
With all due respect a strep throat and D&V (unless you have comorbidities) are not emergencies and there is definitely a problem with the system if people are being encouraged to go to the ER, instead of their PCP (which would be more appropriate) whether they are on medicaid or not.

I think she is referring to times when the PCP and/or urgent care was closed.

This happened to me once, as well. I had what I thought was a viral something the Tues before Thanksgiving. It kept getting worse until Thanksgiving Day I thought I was literally going to die. My PCP was closed. I went to urgent care at 1830, only to find it had closed half an hour earlier. So....I had to go to the ER. Turned out to be strep throat. You can bet your bird I didn't want to be in the ER on Thanksgiving for something like strep. But I had no other choice, and spent my holiday getting a Bicillin shot in my backside.

I think this is what she's talking about....

Specializes in med-surg, psych, ER, school nurse-CRNP.

tom,

The lady was not "standing up for her rights", she was having a hissy fit. The manager was not unjust, the WIC coupons were very specific about what was and was not allowed. The child's "wishes" were really impossible to assess, she was about 4 months old. She could not have told us if she would drink any other type juice. It would not have changed the outcome. This was not about rights, it was about entitlement. She saw fit to blatantly ignore what was plainly posted and then try to cause problems when she did not get her way.

It was assault, I believe the manager did press charges, as she well should have. Would you hit someone in the head with a glass bottle when they told you that you are not allowed to do something?

Specializes in Hospice.
Heron,

May you never have a catastrophic event in your life, after all those years you've worked or are working towards and then poof, your assetts are above the legal limit to qualify for help when your short and long term disability run out and your savings and your 401K so you will have the gov't whether it is SSDI or Medicaid or Medicare left to help you. And do you think they are going to tell you no? They will help you with their monies received from you and your work years along with all other decent working people, and educated. Why, because you will be in need.

It's easy to have the opinion that people on these systems are worthless when actually many have worked as hard if not harder than you and something terrible happened in their life. In other words, IMO be careful for what you wish for, yes there are abusers and generations of abusers of these systems,but belive me they are the minority.

Sharon --- Please don't patronize me or take my words out of context. My post was a reply to one that bemoaned the loss of inherited wealth. Furthermore, you don't know what I've lived through ... I survived 2 New England winters with a toddler and no heat because I was over-income for fuel assistance. I fed, clothed and sheltered 2 people on one income at a time when nurses made squat. So, yes, it is easy to have an opinion because I have walked the walk on both sides of the tracks.

I believe that we need to STOP demonizing each other. Some people do abuse the system and it's legitimate to get upset about that. There are also some people who are unfairly stereotyped, do not get the help they deserve and it's equally legitimate to get upset about that, too. If we keep invalidating each other, how are we going to hear the others' truth? Heron

Specializes in IM/Critical Care/Cardiology.
Why is it my responsibility to work and pay into a system so someone else can inherit wealth they never earned? How is that different from using the system to pay your way so you won't have to get up and go to work?

Heron,

Sorry you felt patronized from my post, truly. But this is the debate issue information I had to counter with. Does it mention anything about previous hardships and being on both sides of the track?

Your asking about your responsibility to work and pay into a system so someone else can inherit wealth they never earned. You continue with questioning the difference "to pay your way" so you won't have to get up to go to work.

With this information I countered that I had once been in the workforce (30 years) and was misdiagnosed. I continued on the discusion as to what I had to go through because of my need, not want.

Hopefully you can appreciate where and why and how I responded to your post now.

I am sorry for the terrible conditions you once had to endure. I simply was countering in a lively debate. I can't read minds, but I do read posts.

Sharona

Specializes in Emergency.

quote "on another note,

my mother is on medicaid, since having colon ca back in 1992. she did have major medical, but the company tried to say that my dad lied (which he didn't) about her having epilepsy and dropped her just before surgery. the first few years that i went to the reviews to renew her medicaid, the county assistance people acted like i was trying to scam them. they were very demoralizing! my parents had to practically live in poverty to qualify. my dad over the years had to cash in life insurance policies, not work quite as hard (he was part owner of an automotive shop) and a variety of other things to come in below the cash income levels. "

doesn't anyone else see anything wrong with this? an able-bodied man chose to work less so that he could have government assistance? so the extra shifts that i work to pay my bills - the extra taxes go to help him so that he can work less? :angryfire

Specializes in ER/EHR Trainer.

You don't get it....$5.00 can make the difference between qualifying or not. Making that extra $100.00, does not pay for the medical insurance required for cancer or any other major illness. Are you kidding? My suggestion to all of you with problems supporting Medicaid or any other government sponsored insurance is to volunteer in a church, soup kitchen or other "giving" agency....no clinics....talk to the people....see what their lives are like.....and don't judge. Walk a mile in their shoes....or just a block. You might change your mind.

Medicaid would work, if all doctors were made to take it. So if patients are cranky....I'd start there.

Maisy

Specializes in LTC, Urgent Care.
Quote

Doesn't anyone else see anything wrong with this? An able-bodied man chose to work less so that he could have government assistance? So the extra shifts that I work to pay my bills - the extra taxes go to help him so that he can work less? :angryfire

Do you think my dad wanted to go that route? He was a proud man. He didn't want every aspect of his finances gone over with with a fine toothed comb. But he loved his wife and did what he had to do for her.

Guess you would have rather seen my mother die from colon cancer than go on medical assistance, huh? Wonder if you'd feel the same way if the shoe were on the other foot???

Oh and btw, even tho he qualified right along with my mother for medicaid services, not once did he use his "benefit".

Thank god for Hospice. Because that same major medical insurance that he had back then, didn't cover the darn near $200 bottles of Oxycontin that he needed when he was dying of colon cancer.

My honest opinion is this. How much does a Medicaid card cost to the actual person (not society or the tax payer)? You mean it is free? How much is the co pay for an ER visit? There isnt one?

Can someone tell me where to exchange my insurance card that costs me about 200 dollars a month and has a 100 dollar co pay for the ER with one of these Medicaid cards?

I would give up my card right now for a Medicaid card, not being sarcastic but I am being dead serious. The problem is that current system encourages less work, that is a major factor that keeps many disabled people from seeking employment. They lose their medicaid (which despite what some people think) is much better than nothing at all or bare bones insurance with co pays).

Specializes in ER/EHR Trainer.

The actual medicaid card costs the user their pride....that is alot more costly than money.

Are you aware that doctors DO NOT HAVE TO TAKE MEDICAID?

Hospital referral doctors DO NO HAVE TO TAKE MEDICAID.

SPECIALISTS DO NOT TAKE MEDICAID-GOD FORBID YOU HAVE AN ILLNESS REQUIRING ONE.

Hospitals will treat, then street your emergent condition.

There can be no follow up on your chronic conditions if you have no medical doctor to work with.

You are forced to deal with students, residents, and be the learning dummy.

You wait hours to be seen in clinics, that is if you can get an appointment or have access to the city a clinic may be in.

Oh you do get your medications paid for.....but then again, you need to get a doctor.

The difference between private insurance and Medicaid IS A WORLD OF DIFFERENCE!

Desperate times, make desperate people. Perhaps, if someone is cranky, nasty, or on the defensive....they have learned to be from those of you who obviously feel Medicaid is a free ride. There is no such thing. Just look at your statements....already they are less than the rest of us...not working, lazy, blah blah blah....lots to say about people we don't know...hmm....

Maisy

Specializes in IM/Critical Care/Cardiology.
Heron,

Sharon --- Please don't patronize me or take my words out of context. My post was a reply to one that bemoaned the loss of inherited wealth. Furthermore, you don't know what I've lived through ... I survived 2 New England winters with a toddler and no heat because I was over-income for fuel assistance. I fed, clothed and sheltered 2 people on one income at a time when nurses made squat. So, yes, it is easy to have an opinion because I have walked the walk on both sides of the tracks.

I believe that we need to STOP demonizing each other. Some people do abuse the system and it's legitimate to get upset about that. There are also some people who are unfairly stereotyped, do not get the help they deserve and it's equally legitimate to get upset about that, too. If we keep invalidating each other, how are we going to hear the others' truth? Heron

I hear ya $3.85/hr as a single parent without benefits pretty much allows my memory to serve me well.

The actual medicaid card costs the user their pride....that is alot more costly than money.

Are you aware that doctors DO NOT HAVE TO TAKE MEDICAID?

Hospital referral doctors DO NO HAVE TO TAKE MEDICAID.

SPECIALISTS DO NOT TAKE MEDICAID-GOD FORBID YOU HAVE AN ILLNESS REQUIRING ONE.

Hospitals will treat, then street your emergent condition.

There can be no follow up on your chronic conditions if you have no medical doctor to work with.

You are forced to deal with students, residents, and be the learning dummy.

You wait hours to be seen in clinics, that is if you can get an appointment or have access to the city a clinic may be in.

Oh you do get your medications paid for.....but then again, you need to get a doctor.

The difference between private insurance and Medicaid IS A WORLD OF DIFFERENCE!

Desperate times, make desperate people. Perhaps, if someone is cranky, nasty, or on the defensive....they have learned to be from those of you who obviously feel Medicaid is a free ride. There is no such thing. Just look at your statements....already they are less than the rest of us...not working, lazy, blah blah blah....lots to say about people we don't know...hmm....

Maisy

I have decent insurance, again I would honestly trade my card for it though. Medicaid is really nice if you have huge hospital bills. Would a person on Medicaid have to pay 10,000 dollars of a 100,000 bill? How about the people who dont have insurance and dont qualify for Medicaid. Or those that work and have insurance that have a high deductible and limited coverage. Those are the people I feel most sorry for. Again a Medicaid card is better than nothing and these people should be very appreciative for it but I have said it many times, with the amount of taxes we pay--everyone should get free care. It happens quite frequently that people quit their jobs and their insurance so they can qualify for Medicaid. It does have advantages over private insurance.

Does it cause as much pride loss as the working poor or middle class who cannot afford to pay their doctor bill?

Are you aware that doctors do not have to take those who cannot afford to pay either?

The same hospital referral doctors also do not have to take someone who cannot pay and many times I have seen people denied because they did not have up front money to give.

Hospitals will treat and street anyone. The difference is, if you dont have Medicaid or if you do have insurance you are likely to also have a 100-1000 dollar bill (or more if no insurance) plus you get to spend another 100 on your medication you was prescribed.

There can also be no follow up if you cannot afford to pay for it.

I often have to wait an hour when I go to my doctor, if I go to an urgent care sometimes it is at least an hour or several hours to be seen.

+ Add a Comment