The truth about Medicaid - for anyone who thinks it still exists.

Since I'm on Social Security Disability and dependent on Medicaid until Medicare kicks in for me sometime in 2007, I'm going to outline what it's like for people who have to rely on Medicaid (despite all those happy things the pols in Washington are saying about the program).

First of all, my monthly SSDI income is $1134 per month. If I want Medicaid, I have to pay the State of Utah $316 per month to get coverage (spend down). That's about 25% of my income - what would you say to your employer if they forced you to fork over 25% of your pay for medical coverage? So to even get Medicaid, I have to hand over 25% of my income to the state and live on $818 per month. How many apartments have you seen that you can pay for with $818 per month, especially when even low income apartments require you to have income 2.5 times the rent to live there?

If I don't have medical bills that month (and thus the spend down is more than my medical bills), I can choose not to have coverage that month. If I go two months without coverage, then I'm dropped from Medicaid. (Since people on SSDI are required by law to be covered by Medicaid until Medicare kicks in, I'm not sure HOW they reconcile this with federal law since I end up getting dumped from Medicaid, but that's the way it works.)

So, if I have medical bills that are more than $316 per month, I sign up for Medicaid. The initial claim takes up to 6 months to process, but in my case since I've been on it before and was dropped for not using it for 2 months, it takes 2 months to process the paperwork to put me back on Medicaid with the spend down. You have to pay the spend down up front before you get coverage. No doctor in Utah will see you unless you already have the Medicaid card in hand.

Hospitals will see you without the card, but they write or call you almost every day to try to get payment during the time that Medicaid is processing your paperwork. They also pretty routinely refer you to another hospital because "they don't have the equipment" to help you. What hospital doesn't have the equipment?!! Medicaid does nothing about this, but they do give YOU a hard time over it.

OK, so you've paid your spend down and have your Medicaid card. Now you go to the doctor and sign a sheet that says there are more expenses involved in your treatment than Medicaid pays, and there's no way to itemize these. So if you want treatment, you basically have to sign papers that say you'll pay some unknown amount BEYOND your spend down for whatever additional expenses the doctor charges. If you don't pay those additional charges, the NETWORK can ban you from receiving additional services from all the doctors and hospitals in the network.

In my case, I had a medical emergency after I had been dropped from Medicaid. I went to my network provider, and was dumped to another hospital. I was referred by that hospital to a doctor with the hospital for surgical evaluation - per doctor instructions, I was supposed to have something done within 1 week of being seen in the Emergency Room. The doctor I was referred to by the hospital refused to see me unless I had the Medicaid card in hand, and also had the handy paperwork up front that you have to sign before treatment that says you'll pay (through the nose) for whatever additional costs the doctor charges you above what Medicaid pays. If you don't sign, the doctor won't see you. So no follow up treatment for me. The problem I had was with abnormal bleeding, and during the visit to the Emergency Room they stopped the bleeding and prescibed 1 month of medication. OK, it takes 2 months to process the Medicaid paperwork. What did I do? I paid for the 1 month prescription out of pocket at a local pharmacy. I went online to an offshore pharmacy that sold medication without a prescription and I bought out of pocket the additional medication I needed. Fortunately, it worked.

What will I end up doing? I'll pay the spend down for the month that I went to the Emergency Room to get the costs of that visit covered (and no doubt there will be more that aren't). I'll then continue the medication from the illegal online pharmacy until my Medicare kicks in and I can actually get the surgery I need for the underlying problem (assuming Medicare hasn't been gutted by then).

And don't think there are any other government programs that take up the slack when you pay through the nose for Medicaid. When I pay the spend down, I still don't qualify for food stamps. I'm number one million something on the waiting list for Section 8 housing assistance (despite the fact that my illegal neighbor from Mexico two doors down is on Section 8). If I pay the Medicaid spend down, I'm pretty much screwed.

IMO Medicaid is a non-existant program that Republicans in Washington are stupidly trying to cut even more. Fools.

Anyone who still thinks Medicaid functions in any way, shape or form, is completely out of their mind.

I receive 674$ per month but I only pay 16$ a month for my medications (And I take a lot of pills) and medical care is totally free.

Cost of living here is higher than Canada, too. I'm a little better off with my income level (I paid huge $$$ into SS to get that extra bit of cash per month, and BushCo is busy plotting to take it all away since they hate the whole idea of SS). But I think we both understand the down side to living on Social Security. It's tough. A little help from the gov't would be nice, instead of constant attacks.

Can I ask some questions? As my mother may soon be in the same position. She has Parkinsons, she is currently working three days a week just for the health insurance. However we do not know how much longer she will be able to work. And she is not eligible for Medicare for another 2 years. If they don't change the age limits.

What is "spend down?" And is this new? I was a Welfare Social Worker in the 90's and don't remember Medicaid being this difficult, at least not in Alabama back then.

Is your Medicaid coverage different then that of a person/child on welfare and foodstamps?

Good luck to you, you are in my thoughts.

If you make less than the poverty line, you don't end up with spend down and can avoid a lot of headaches. The extra you have to pay out of pocket beyond spend down varies from state to state. For that, your best bet is to check with local doctors about their Medicaid policies. Some doctors won't see Medicaid patients at all, so be prepared for that. Every doctor I know of in this state, including those in the Emergency Room, charge additional fees beyond what Medicaid pays. What they do in your state might be different.

WRT spend down. Basically, the state thinks you shouldn't have Medicaid unless your income is below the poverty line (which is pretty dang LOW - around $800 a month for 1 person, and not much more for 2 people). If you make more than the poverty line, you have to hand over to the state everything you make above poverty in order to get Medicaid. Basically, they're dumping you back into poverty to get Medicaid. So if you make $10 more than the poverty level, you pay the state $10. If, like me, you make $316 more than the poverty level, you fork over $316 to the state to get Medicaid (and live in poverty). The less you make, the less you have to worry about spend down.

It is much clearer now. I am ashamed to say that I had NO IDEA about Spend Down. I going to do a lot of research over the next few days.

My friend's father had to sell his home in order to qualify for a long-term care facility (he's in the final stages of MS and has no motor control whatsoever). He had to enter the facility because he couldn't afford a proper home health aide, and the local person he could afford was irresponsible and would forget to visit him for three day stretches -- which meant no leaving bed, no food, no water, and no one to change his waste bags. He kept developing kidney infections and pneumonia every time this bint wouldn't show, and so the doctor refused to discharge him until he could show that he had proper care set up. Because he couldn't do that, long-term care was considered the only option. Having to sell the house was the topper to all this.

It is generally given to those who are on the upper edges of income requirements.
By taking their income, it makes them eligible. Sounds sick, I know, however, the other side is not having healthcare coverage at all at any price.
I paid $850 a month at one time for COBRA because I HAD to have coverage.
I totally relate.

My dad was on Medicaid until he died because he went through all of his savings when he got sick.

He had SS of $1490 per month, plus a small pension. Medicaid paid everything. His drugs, his incontinence pads, everything.

When he went into the nursing home, he got to keep $30 a month, which he didn't need because we were essentially paying for the extras, clothes, etc.,

Medicaid was a godsend for us. Prior to his going on Medicaid, he had $800,000 in savings, but the nursing home visits ate it all. Then, we were paying (my brothers and I) $9000 a month for home care until my mom passed. Then we would have had to pay for 24 hour care and just couldn't do it.

Get a doctor on your side, as well as a case worker who is willing to explain the ins and outs. Medicaid is the best insurance available, because EVERYTHING is covered. You just have to get someone who knows what they are doing.

is from years past when Medicaid actually still worked. My father was on Medicaid in Florida before he passed away this last July. Medicaid took everything he had, and there were still additional medical expenses billed to him. My dad also had Medicare with supplimental coverage - he still got nailed in Florida for medical bills. He ended up in a nursing home. Because Medicare and the supplimental didn't pay for everything, he had to use Medicaid (and forked over his entire SS check). My brother is still dealing with all the medical bills they keep sending for my dad, even though he passed away 5 months ago. Since my dad had no estate left and we (his children) have no legal obligation to pay them, my brother just dumps the medical bills in the trash. They keep sending them, though.

to your brother and the bills. My brother and I had the same issue. Luckily we were not listed as "guarantors" on his medical bills. We sent the creditors a copy of his death certificate, even though our attorney said we did not have to. When we closed up his house, we had his mail forwarded to a post office box, so that it was not coming to either of us. Once the forwarding order expired we stopped receiving any bills, I assume they are being returned to the senders.

He qualified in CT, and then as a federally covered life, when he moved to VA with me, he was still covered.

Are you sure the medical bills aren't from Medicare? Because every individual on Medicaid is entitled to 100 days in the hospital each calendar year which is then billed to Medicare. The catch is, you have to let them know that he also has Medicaid, so that when the Medicare portion/supplemental is paid, it will roll over to Medicaid.

I had to go through the same thing, but once I told them to bill Medicare, his supplemental and then Medicaid, no more problems.

Medicaid didn't take what my dad had. He used it to pay for his health care and then had to rely on Medicaid for about 2 years.

Frankly, for me and my family, it was one instance where the government didn't screw us.

They let him keep $30. We didn't know at the time if he was going to go home after recovering in the nursing home, so my brother had to pay all my dad's expenses while he was in the nursing home because Medicaid took his SS checks. In the end, my father passed away instead of going home. The only reason why my dad kept his house was that it had a homestead exemption and my brother made the payments on it while my dad was sick. Otherwise, my dad would have lost everything, and if he had gone home instead of passing away, he wouldn't have had a house to go home to.

to pay for the tax breaks for the rich.
Medicaid worked great, so it had to be broken.
I am glad your experience was a good one though.

He passed in July of 2004, so it was a pretty recent experience as well.

And am in disbelief to those who say it isn't.
There is a better way. We just aren't going to do it because rich people can still afford medical care.
The only way we will get nationalized care in this country is when rich people can't afford it.
Then it will be considered a national emergency.
I'm afraid that day won't be coming.:(

suffer waiting for government asistance with their obscene medical bills - especially in the bad old days of the epidemic.
but it still goes on.

i had a job and had horriffic medical care care costs and no insurance for a long time in my life.

we hate the poor in this country and take every opportunity to punish them for their circumstance.

"Medicaid is the best insurance available, because EVERYTHING is covered."
The forced Rx program of next year just destroyed much of medicaid support, and more cuts will be forthcoming! Now those who have medicaid to cover Rxs will be forced to put out a co-pay for EACH Rx.
Those who choose to stop taking needed Rxs will have to be hospitalized or nursing homes at much greater costs, so there will have to be cuts made there too. Home care recipients have already been cut to the extent that they, too, will have to have care in some type of assisted living at greater cost. If they didn't already have a plan for untimely death of millions, they wouldn't create this!

They're not cheap, either. I think it's $10 per (not batch, I don't think, but per script). To be honest, because the rest of Medicaid is so screwed up, I just fork over out of pocket for meds.

For example in my home state of Pennsylvania the Spend down Program requires you to spend down to the amount you would get on Welfare ($174 in my home county, $206 in Philadelphia County). Then and only then will the State pick up the rest of the bill.

On the other hand, Pennsylvania has a law on the books forbidding Doctors from charging more than what Welfare will pay on the Medicaid program. Thus the contracts you sign to pay over and above what Medicaid will pay for is illegal in Pennsylvania by State law (And may be illegal in All states by the Federal Law setting up Medicaid in each state).

Thus each state has its own rules, but driven by the Federal law governing Medicaid. Furthermore each state can ask for a "Wavier" of a Federal Requirement and if agreed to the State can provide even less coverage. Medicaid is getting cut left and right to Balance both the State and Federal Budgets. The leadership of the GOP both at the State and Local Levels are so blinded by the idol of Tax Cuts that they will leave people die rather than raise taxes to provide the services needed. This is reinforced by the GOP's other Idol of projects for back home (Pork). The GOP leadership believes Pork will get them re-elected but increase in Welfare will NOT. This is the same mental outlook the GOP had in the 1920s and I fear the Country needs a few more years of it to teach a new Generation of Americans that the GOP is NOT the party of Americans but of fat-cats.

this spend-down shit right now. He has to itemize everything to prove he can continue to get title 19. I am completely confused by it all. I hate the government for putting people through this. Good luck to you.

What made you change over?

That seems the only explanation, in retrospect. I just got sick of all the garbage in the party and I couldn't take it anymore. If I tried to make them see reason, they just blew me off and retaliated. I'd had enough.