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.

Specializes in ER/EHR Trainer.

This post is about Medicaid....so that is the information I am providing, as well as, my own private experience. I live in an area where medical coverage abounds and Medicaid recipients are abused (as far as I am concerned) by the medical community.

If you'd like to make it about all, then I believe all Americans deserve access to GOOD healthcare. I understand the plight of the working poor, underinsured and non-insured. Have been there. Currently, I work for the largest hospital system in the state, it's NJ 3rd largest employer....our healthcare system is hospital based...our physicians do not want to take it....how about that, doctors not wanting to care of those they work with? Why? It's a crappy system....I am lucky and have a PPO with my husband's international company....GET IT...International company that provides GOOD healthcare.

The problem with us is us...as long as we put up with the status quo in healthcare. We will get as a group what we deserve. I will always talk up for the disadvantaged. I will speak Spanish (badly) to those who need it and point them in the right direction. I will find the answers to questions put to me by those who don't know the system. And I will continue to educate the ignorant and challenge them to live that day in another's shoes. Until you've drowned, you can't even imagine.

Why will I do this? Because I was graced with the brain and ability to do so. Because I have a social conscience. Because I believe that is truly our mission while alive, and as healthcare workers. What's the point of inhabiting a spot on this earth, unless you are here to make it better?

JMHO

Maisy;)

PS For those of you who boo hoo yours, you sound like those who "are going to get mine" See any correlation?

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.

You are missing the HUGE point here, you have to be DISABLED to get Medicaid, or you need to be an unwed mother. If you think it is easy to get approved for SSI or SSDI you are very wrong. Here are a couple of links to websites that people post to who have been fighting to get SSDI or SSI for two, three and sometimes more years and a blog written by a ex disability examiner(worked for the SSA). These people lose everything (home, savings, health insurance) in this interum, but maybe it is easier to believe that disabled folks can actually go out there and work. Disabled people are DISABLED because they CANNOT work, why is this such a hard concept to embrace?

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).

Hopefully no one will ever become disabled. Anyone who has to go through this is in for a really rude awakening.

http://groups.msn.com/SocialSecurityDisabilityCoalition/general.msnw?action=get_threads

http://www.disabilityblogger.blogspot.com/

Specializes in ER, PACU, Med-Surg, Hospice, LTC.
Disabled people are DISABLED because they CANNOT work, why is this such a hard concept to embrace?

Actually, this is partially incorrect. Receiving SSDI and working at the same time has to do with what is considered Substantial Gainful Employment. A person can receive SSDI and still work. They just may not be working and bringing in more money than what is considered SGA.

Here is the link to the Social Security site that will explain it more clearly and more accurately than I can.

Explaination of SSDI and the Ability to Continue Working

I have a neighbor in SSDI and works. He is on SSDI because of Anger Management Issues. He apparently does not play well with others.

He repairs cars, does yard work and repairs roofs for extra money to supplement his SSDI, but he does not earn more than the dollar amount that the Government allows per month because if he does go over that amount, he will lose his monthly SSDI checks and all of his medical care.

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

There's a post on the Phillipine Nursing board about how paying and non-paying patients are segregated, and the non-paying patients really do get inferior care.

I have a neighbor in SSDI and works. He is on SSDI because of Anger Management Issues. He apparently does not play well with others.

Go to my post #298 for more on this.

Actually, this is partially incorrect. Receiving SSDI and working at the same time has to do with what is considered Substantial Gainful Employment. A person can receive SSDI and still work. They just may not be working and bringing in more money than what is considered SGA.

Here is the link to the Social Security site that will explain it more clearly and more accurately than I can.

Explaination of SSDI and the Ability to Continue Working

I have a neighbor in SSDI and works. He is on SSDI because of Anger Management Issues. He apparently does not play well with others.

He repairs cars, does yard work and repairs roofs for extra money to supplement his SSDI, but he does not earn more than the dollar amount that the Government allows per month because if he does go over that amount, he will lose his monthly SSDI checks and all of his medical care.

You are correct, IF the persons disability is not so severe they can work a very limited amount of hours.There are many disabled that can no longer work AT ALL .I honestly dont know why anyone would accept SSDI or SSI if they could work, maybe they could not earn enough wages on such limited working hours to be able to exist in our economy.
You are missing the HUGE point here, you have to be DISABLED to get Medicaid, or you need to be an unwed mother. If you think it is easy to get approved for SSI or SSDI you are very wrong. Here are a couple of links to websites that people post to who have been fighting to get SSDI or SSI for two, three and sometimes more years and a blog written by a ex disability examiner(worked for the SSA). These people lose everything (home, savings, health insurance) in this interum, but maybe it is easier to believe that disabled folks can actually go out there and work. Disabled people are DISABLED because they CANNOT work, why is this such a hard concept to embrace?

Hopefully no one will ever become disabled. Anyone who has to go through this is in for a really rude awakening.

http://groups.msn.com/SocialSecurityDisabilityCoalition/general.msnw?action=get_threads

http://www.disabilityblogger.blogspot.com/

I really dont feel I am missing the point. My point is this. Medicaid is much better than what many people have. It isnt perfect but still pretty dang good and as I have posted it will protect you from a huge bill if you have a catastrophic injury.

I think for many it is difficult to get approved for SSI but for a few who know how to work the system, it seems to be a bit easier.

As far as your line about disabled people, I just dont understand it. Disabled people work everyday, the ADA has been instrumental in creating a workplace they can thrive in. There are still barriers but physical disabilities are being overcome. Mental/Cognitive barriers admittedly are much harder. But my last nursing job housed an occupational rehabilitation center.

I have seen a quad take a supervisory position in a hospital. The best social worker I have ever seen went through their program. So humans are capable of unimaginable things.

But my point was this--and it ties into Medicaid. Often these people who are disabled have chronic conditions that are relatively expensive. Once they lose their Medicaid they can actually lose money by working. Private insurances has the co pays or deductibles that make it really difficult for them.

Perhaps our biggest problem is that Medicaid is different based on state. In my state, WV, I can honestly tell you it is pretty good insurance with almost no out of pocket expenses.

Specializes in ER, PACU, Med-Surg, Hospice, LTC.
You are correct, IF the persons disability is not so severe they can work a very limited amount of hours.There are many disabled that can no longer work AT ALL .I honestly dont know why anyone would accept SSDI or SSI if they could work, maybe they could not earn enough wages on such limited working hours to be able to exist in our economy.

That is correct. There are many that can still work (and do), but not enough to support themselves. Although, ever see the average amount a month that a person on Disability receives? Something like $625 a month. Who in the heck can live on that???

Anger management issues qualify you for SSDI? (Maybe I WILL throw that temper tantrum after all!)

:) mc3

I work in an outpatient diagnostic testing facility. It is frustrating for us because the majority of no-shows are medicaid subscribers. This is an everyday headache that obviously wastes time and takes up an appointment slot that another patient could have had. It is also frustrating because these procedures run into the thousands of dollars, and medicaid patients have no idea, whereas our patients with insurance fret over whether they will be left with a bill they can't pay, that is, if the test is even authorized by their insurance to begin with. We are located in an economically depressed area, and our patients with regular insurance are certainly not living in the lap of luxury, and they oftentimes have to debate whether they can have a procedure versus paying some other bills, etc. I personally have no health insurance, so it's extremely maddening to me when state of the art testing is at someone's disposal, and it isnt taken seriously by keeping (or simply calling to cancel, imagine that?) an appointment.

Specializes in Rehab, Infection, LTC.
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

I just wanted to agree with this post. $5 really CAN make a difference.

my first husband was dx with acute intermittent porphyria and was so terribly sick. when we lost his income we were destitute (sp). we were living on my $275/week as a bookeeper.

we applied for disability for him. the woman i talked to on the phone told me that it would take 3 years and we would need a lawyer to prove the disability. she said over 90% of applications were denied the first time. we were lucky. they approved him within 6 months.

during that 6 months we applied for SSI. I made $50 a month too much for us to get help. FIFTY DOLLARS A MONTH! I told the lady i could take a pay cut but she said that i couldnt do that.

know what she told me to do? we had been married 6 months. she told me to divorce him so he would be approved for assistance. she said while we were married with no children we wouldnt approve for any assistance at all. NONE!!

so my government, the US government's solution was for me to divorce my husband so he could get the SSI, food stamps and anything else he could get. Ihad purchased an independent insurance policy for him before he was dx with the AIP. i couldnt drop it so he could get Medicaid. they wouldnt give it to him. he was in the hospital for 1-2 months at a time 4-5 times a year. if he could have gotten the medicaid, they would have paid the bills. as it is...he is now dead, i am remarried and STILL paying on those bills.

how's that for moral values of the country?

sorry for running on...i get upset about this subject. i've seen soooo many people that didnt deserve assistance. people that could work but wont so they can get assistance. but 2 hard working young people, add in a catastrophic illness and we were screwed.

Specializes in Rehab, Infection, LTC.
AMEN - I recently moved to the rural south from Maryland, where I lived in one of the most affluent counties in the country. Most of my neighbors were inexcusably rude. They were impatient and demanding and all thought they were my only patient. They were much too busy to wait in line or wait their turn. THey allowed others to raise their children, then blamed everyone when they turned out to be brats. Of course, not everyone was like that, just as not all poor people on Medicaid are rude and demanding. But having known both groups, I would prefer to work with southern Medicaid any day. At least I can rationalize their bad behavior with poor upbringing and lack of education.

at my facility we dont accept medicaid. we only accept medicare, insurance or private pay.

rudeness comes from all walks of people. my building is full of rude people and notone of them are on medicaid.

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