What's your experience with Medicaid ?

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mav12
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What's your experience with Medicaid ?

Post by mav12 » Fri Dec 01, 2017 1:36 pm

Does anyone have or had Medicaid?

Is it pretty bad as far as coverage?

Rupert
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Re: What's your experience with Medicaid ?

Post by Rupert » Fri Dec 01, 2017 1:48 pm

How good or bad it is often depends on what state you're in because it's a state-administered program. You'll get better answers if you tell people what state you're asking about.

dbr
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Re: What's your experience with Medicaid ?

Post by dbr » Fri Dec 01, 2017 2:27 pm

I am involved with people who are in/under/provided for by "Medicaid" in this state.

To answer your question you would have to be specific as to exactly what situation you have and also what state you are in. It is also a question of exactly what support you mean when you say Medicare. My experience has to do with both people getting support due to disabilities and also elderly people under Medical Assistance in a Nursing Home or on Elderly Waiver in Assisted Living. These may not be exactly Medicare as you mean the term.

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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Fri Dec 01, 2017 2:34 pm

dbr wrote:
Fri Dec 01, 2017 2:27 pm
I am involved with people who are in/under/provided for by "Medicaid" in this state.

To answer your question you would have to be specific as to exactly what situation you have and also what state you are in. It is also a question of exactly what support you mean when you say Medicare. My experience has to do with both people getting support due to disabilities and also elderly people under Medical Assistance in a Nursing Home or on Elderly Waiver in Assisted Living. These may not be exactly Medicare as you mean the term.
The OP referred to Medicaid not Medicare.

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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Fri Dec 01, 2017 2:36 pm

Rupert wrote:
Fri Dec 01, 2017 1:48 pm
How good or bad it is often depends on what state you're in because it's a state-administered program. You'll get better answers if you tell people what state you're asking about.
1. My understanding (speaking with folks I know) is that this is very true.

2. Some HMOs enroll patients under Medicaid. I suspect that such patients probably receive care from the same providers as those in the HMO not on Medicaid.

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Re: What's your experience with Medicaid ?

Post by dbr » Fri Dec 01, 2017 2:39 pm

dm200 wrote:
Fri Dec 01, 2017 2:34 pm
dbr wrote:
Fri Dec 01, 2017 2:27 pm
I am involved with people who are in/under/provided for by "Medicaid" in this state.

To answer your question you would have to be specific as to exactly what situation you have and also what state you are in. It is also a question of exactly what support you mean when you say Medicare. My experience has to do with both people getting support due to disabilities and also elderly people under Medical Assistance in a Nursing Home or on Elderly Waiver in Assisted Living. These may not be exactly Medicare as you mean the term.
The OP referred to Medicaid not Medicare.
That was a misspeak. I am talking about state administered programs for those with low income and disability/public assistance issues. Example is here: https://www.payingforseniorcare.com/med ... derly.html

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Re: What's your experience with Medicaid ?

Post by Carefreeap » Fri Dec 01, 2017 2:54 pm

dm200 wrote:
Fri Dec 01, 2017 2:36 pm
Rupert wrote:
Fri Dec 01, 2017 1:48 pm
How good or bad it is often depends on what state you're in because it's a state-administered program. You'll get better answers if you tell people what state you're asking about.
1. My understanding (speaking with folks I know) is that this is very true.

2. Some HMOs enroll patients under Medicaid. I suspect that such patients probably receive care from the same providers as those in the HMO not on Medicaid.
And in some cases get better coverage!

My dad is on Medicaid. Both he and his gf (same age) get their medical coverage through Kaiser (of So. CA). She is covered by Medicare but pays for a supplement. Dad's coverage is actually better than hers.

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Re: What's your experience with Medicaid ?

Post by Rupert » Fri Dec 01, 2017 4:59 pm

Consider this an amendment to my earlier comment: Medicaid patients almost always have access to doctors and hospitals affiliated with state-run medical schools. So if you're in a city with a decent state medical school and hospital, odds are Medicaid patients in your city at least theoretically have access to excellent care. (I say "theoretically" because getting an appointment with a doctor at one of those state facilities can be difficult. Their clinics are typically packed.) In rural areas and cities without state facilities, quality of care and access to care is hit or miss.

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rustymutt
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Re: What's your experience with Medicaid ?

Post by rustymutt » Fri Dec 01, 2017 6:53 pm

That it depends more on the state you''re in, than most would think.
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Re: What's your experience with Medicaid ?

Post by mav12 » Sat Dec 02, 2017 12:16 am

Rupert wrote:
Fri Dec 01, 2017 1:48 pm
How good or bad it is often depends on what state you're in because it's a state-administered program. You'll get better answers if you tell people what state you're asking about.
Oregon

mav12
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Re: What's your experience with Medicaid ?

Post by mav12 » Sat Dec 02, 2017 12:19 am

dm200 wrote:
Fri Dec 01, 2017 2:34 pm
dbr wrote:
Fri Dec 01, 2017 2:27 pm
I am involved with people who are in/under/provided for by "Medicaid" in this state.

To answer your question you would have to be specific as to exactly what situation you have and also what state you are in. It is also a question of exactly what support you mean when you say Medicare. My experience has to do with both people getting support due to disabilities and also elderly people under Medical Assistance in a Nursing Home or on Elderly Waiver in Assisted Living. These may not be exactly Medicare as you mean the term.
The OP referred to Medicaid not Medicare.
True, my mom is on Medicare and it is a different game, which I would have to research later to help her out.

Spirit Rider
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Re: What's your experience with Medicaid ?

Post by Spirit Rider » Sat Dec 02, 2017 12:56 am

The variety of coverage by state is so true. We went from the worst access to patient care for Medicaid patients to one of the best.

My state has had an ACA waiver since 2016. They enroll most Medicaid qualified individuals in the four lowest cost ACA Silver plans with 100% cost sharing.

The Individuals get full access to the entire carrier's provider network. Medicaid patients are on a level playing field with all other patients.

Which is a lot better than prior to 2016 when the Medicaid provider lists were pretty much the bottom of the barrel.

Contrary to a previous response there were no quality doctors available from hospitals. In fact none of the hospital affiliated physician practices accept any Medicaid patients.

dbr
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Re: What's your experience with Medicaid ?

Post by dbr » Sat Dec 02, 2017 10:34 am

mav12 wrote:
Sat Dec 02, 2017 12:19 am
dm200 wrote:
Fri Dec 01, 2017 2:34 pm
dbr wrote:
Fri Dec 01, 2017 2:27 pm
I am involved with people who are in/under/provided for by "Medicaid" in this state.

To answer your question you would have to be specific as to exactly what situation you have and also what state you are in. It is also a question of exactly what support you mean when you say Medicare. My experience has to do with both people getting support due to disabilities and also elderly people under Medical Assistance in a Nursing Home or on Elderly Waiver in Assisted Living. These may not be exactly Medicare as you mean the term.
The OP referred to Medicaid not Medicare.
True, my mom is on Medicare and it is a different game, which I would have to research later to help her out.
But I referred to Medicaid and simply miss-typed. My question was about what aspects of Medicaid as there are many different programs rolled up under that label. My experience is with low income, disabled, possibly elderly and using in-home or institutional assistance. Your question may be about health insurance.

staythecourse
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Re: What's your experience with Medicaid ?

Post by staythecourse » Sat Dec 02, 2017 10:45 am

Spirit Rider wrote:
Sat Dec 02, 2017 12:56 am
Medicaid patients are on a level playing field with all other patients.
Not usually true. Just because a system, hospital, or clinic take medicaid doesn't mean they have the same access. I'm a doc and worked at a hospital as a specialist and limited the number of new medicaid patients I saw each month. Was the hospital happy about it? Who knows. They knew I was doing it to generate better profits for them so that is all they cared about. Many docs do the same thing. I'm a solo guy now and will not take it at all. Most of the good specialists won't take it as it is money loser. So is their access to the same services? Maybe. Is it equal? Try calling a doctor's office (at least private) and see what they say when you say you have medicaid.

The above poster is correct that medical schools/ teaching hospitals take it so if you have one nearby then not an issue as they have primary care, specialists, and ancillary services (imaging, PT, etc..) on site.

Good luck.
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Re: What's your experience with Medicaid ?

Post by samsoes » Sat Dec 02, 2017 10:47 am

Beware of Medicaid "clawback" provisions where states back-bill a decedent's estate. Traditional Medicaid clawback likely didn't yield much money since the recipients were mostly poor. With the ACA, however, there isn't an asset test to qualify for expanded Medicaid. As a result, an ACA-Medicaid recipient may have quite an estate upon death. Clawback provisions have been a part of Medicaid before the ACA and many states still use it to recoup funds after a person's death.
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knpstr
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Re: What's your experience with Medicaid ?

Post by knpstr » Sat Dec 02, 2017 10:52 am

My experience with Medicaid is that it doesn't pay your doctor very well.
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Spirit Rider
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Re: What's your experience with Medicaid ?

Post by Spirit Rider » Sat Dec 02, 2017 11:02 am

staythecourse wrote:
Sat Dec 02, 2017 10:45 am
Spirit Rider wrote:
Sat Dec 02, 2017 12:56 am
Medicaid patients are on a level playing field with all other patients.
Not usually true. Just because a system, hospital, or clinic take medicaid doesn't mean they have the same access. I'm a doc and worked at a hospital as a specialist and limited the number of new medicaid patients I saw each month. Was the hospital happy about it? Who knows. They knew I was doing it to generate better profits for them so that is all they cared about. Many docs do the same thing. I'm a solo guy now and will not take it at all. Most of the good specialists won't take it as it is money loser. So is their access to the same services? Maybe. Is it equal? Try calling a doctor's office (at least private) and see what they say when you say you have medicaid.

The above poster is correct that medical schools/ teaching hospitals take it so if you have one nearby then not an issue as they have primary care, specialists, and ancillary services (imaging, PT, etc..) on site.
Read my post again.

"My state has had an ACA waiver since 2016. They enroll most Medicaid qualified individuals in the four lowest cost ACA Silver plans with 100% cost sharing."

My state's Medicaid purchases ACA market place Silver Plans, pays the premium and minimum cost sharing at the FPL directly to the carrier. In my goddaughter's case, she has the same exact plan that anyone else can purchase. In fact, the exact same plan I had in 2015. She has an insurance card from the carrier for that ACA Silver plan. The provider deals with the carrier the same as any other individual on that carrier's plan. They receive the same exact reimbursement rates. They may never even know that Medicaid is paying the premium.

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Re: What's your experience with Medicaid ?

Post by Jackson12 » Sat Dec 02, 2017 11:15 am

The OP is in Oregon

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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 11:18 am

staythecourse wrote:
Sat Dec 02, 2017 10:45 am
Spirit Rider wrote:
Sat Dec 02, 2017 12:56 am
Medicaid patients are on a level playing field with all other patients.
Not usually true. Just because a system, hospital, or clinic take medicaid doesn't mean they have the same access. I'm a doc and worked at a hospital as a specialist and limited the number of new medicaid patients I saw each month. Was the hospital happy about it? Who knows. They knew I was doing it to generate better profits for them so that is all they cared about. Many docs do the same thing. I'm a solo guy now and will not take it at all. Most of the good specialists won't take it as it is money loser. So is their access to the same services? Maybe. Is it equal? Try calling a doctor's office (at least private) and see what they say when you say you have medicaid.
The above poster is correct that medical schools/ teaching hospitals take it so if you have one nearby then not an issue as they have primary care, specialists, and ancillary services (imaging, PT, etc..) on site.
Good luck.
I know this is about Medicaid, but there are similar situations where some or many Physicians do not accept new Medicare patients.

I believe that if a Medicaid patient is enrolled in an HMO (such as Kaiser), that Medicaid patient has the same access to Physicians, services, etc. as any other enrollee in that plan.

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Re: What's your experience with Medicaid ?

Post by TG2 » Sat Dec 02, 2017 11:25 am

I know some people who love Medicaid. They qualified under ACA for expanded Medicaid in Washington. Of course, they are generally healthy and do not require much in the way of services, so if there is an inability to access specialists or top-level care (I don't know) it certainly has not impacted them to this point. They did have to find new providers, I think. Having no premiums, deductibles, or co-pays sure helps and that also includes basic or regular dental care and mental health treatment. Washington also passed a law which eliminated the claw-back provisions for care received after age 55. It seemed only fair to do so since people were being diverted into Medicaid under ACA. As far as I know they are very happy with it. Whether that changes if they get hit with a serious issue, who knows? For now, though, it is wonderful.

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Re: What's your experience with Medicaid ?

Post by rustymutt » Sat Dec 02, 2017 11:46 am

samsoes wrote:
Sat Dec 02, 2017 10:47 am
Beware of Medicaid "clawback" provisions where states back-bill a decedent's estate. Traditional Medicaid clawback likely didn't yield much money since the recipients were mostly poor. With the ACA, however, there isn't an asset test to qualify for expanded Medicaid. As a result, an ACA-Medicaid recipient may have quite an estate upon death. Clawback provisions have been a part of Medicaid before the ACA and many states still use it to recoup funds after a person's death.

Not all states agreed to take on the expanded medicaid programs.
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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 12:06 pm

rustymutt wrote:
Sat Dec 02, 2017 11:46 am
samsoes wrote:
Sat Dec 02, 2017 10:47 am
Beware of Medicaid "clawback" provisions where states back-bill a decedent's estate. Traditional Medicaid clawback likely didn't yield much money since the recipients were mostly poor. With the ACA, however, there isn't an asset test to qualify for expanded Medicaid. As a result, an ACA-Medicaid recipient may have quite an estate upon death. Clawback provisions have been a part of Medicaid before the ACA and many states still use it to recoup funds after a person's death.
Not all states agreed to take on the expanded medicaid programs.
Very true. My state (so far) has refused to epand medicaid.

staythecourse
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Re: What's your experience with Medicaid ?

Post by staythecourse » Sat Dec 02, 2017 12:13 pm

Spirit Rider wrote:
Sat Dec 02, 2017 11:02 am
staythecourse wrote:
Sat Dec 02, 2017 10:45 am
Spirit Rider wrote:
Sat Dec 02, 2017 12:56 am
Medicaid patients are on a level playing field with all other patients.
Not usually true. Just because a system, hospital, or clinic take medicaid doesn't mean they have the same access. I'm a doc and worked at a hospital as a specialist and limited the number of new medicaid patients I saw each month. Was the hospital happy about it? Who knows. They knew I was doing it to generate better profits for them so that is all they cared about. Many docs do the same thing. I'm a solo guy now and will not take it at all. Most of the good specialists won't take it as it is money loser. So is their access to the same services? Maybe. Is it equal? Try calling a doctor's office (at least private) and see what they say when you say you have medicaid.

The above poster is correct that medical schools/ teaching hospitals take it so if you have one nearby then not an issue as they have primary care, specialists, and ancillary services (imaging, PT, etc..) on site.
Read my post again.

"My state has had an ACA waiver since 2016. They enroll most Medicaid qualified individuals in the four lowest cost ACA Silver plans with 100% cost sharing."

My state's Medicaid purchases ACA market place Silver Plans, pays the premium and minimum cost sharing at the FPL directly to the carrier. In my goddaughter's case, she has the same exact plan that anyone else can purchase. In fact, the exact same plan I had in 2015. She has an insurance card from the carrier for that ACA Silver plan. The provider deals with the carrier the same as any other individual on that carrier's plan. They receive the same exact reimbursement rates. They may never even know that Medicaid is paying the premium.
No not true. How could you be that naive. Do you really think folks get the same commerical plans at lower cost just because the government and insurance company feel bad that person doesn't have enough money. That is laughable.

The plans are medicaid plans that at distributed through the normal carriers, i.e. United, cigna, aetna, BCBS, etc... (exclude those that have already existed the marketplace). Each carrier has MANY different plans under them. They do not reimburse the same for each. I know as medicaid reimbursement is terrible as I look at the EOBs. Heck, you don't have to be in medicine to figure that out. If medicaid under BCBS paid the same as commercial BCBS why wouldn't everyone be courting the poor?

I've always had a joke in medicine that the more impressive the name of the plan the worst the reimbursement, i.e. gold, sliver, bronze, etc...

Good luck.
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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 12:23 pm

If medicaid under BCBS paid the same as commercial BCBS why wouldn't everyone be courting the poor?


Very true.

Some providers (such as Kaiser in this area) must have figured out how to not lose money on providing (and promoting) their regular services to Medicare and Medicaid recipients.

While, for example, a large percentage of Primary Care physicians in this area will not accept new Medicare patients, plans like Humana and Kaiser advertise their plans aggressively. I have not seen that same aggressiveness for Medicaid - but I do see information promoting Medicaid in this state by Kaiser.

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Re: What's your experience with Medicaid ?

Post by Spirit Rider » Sat Dec 02, 2017 2:40 pm

staythecourse wrote:
Sat Dec 02, 2017 12:13 pm
No not true. How could you be that naive. Do you really think folks get the same commerical plans at lower cost just because the government and insurance company feel bad that person doesn't have enough money. That is laughable.

The plans are medicaid plans that at distributed through the normal carriers, i.e. United, cigna, aetna, BCBS, etc... (exclude those that have already existed the marketplace). Each carrier has MANY different plans under them. They do not reimburse the same for each. I know as medicaid reimbursement is terrible as I look at the EOBs. Heck, you don't have to be in medicine to figure that out. If medicaid under BCBS paid the same as commercial BCBS why wouldn't everyone be courting the poor?

I've always had a joke in medicine that the more impressive the name of the plan the worst the reimbursement, i.e. gold, sliver, bronze, etc...
Yes, it is very true. How could you not do basic research of my post to see if it was possible. Unless of course, you didn't read my full response and neglected to even bother reading the very specific points I made showing why they were commercial policies.

I not only think, but know that in NH, Medicaid enrollee's can get commercial health insurance policies with no premium and little to no out-of pocket costs depending on ACA MAGI. I am well aware of Medicaid plans administered by health insurance. That is what existed previously and still does in NH and why I paid for a commercial policy for my goddaughter in 2015. Starting in 2016, NH received an ACA waiver to offer the Premium Assistance Program:

"If you are a New Hampshire resident between the ages of 19 to 65, and meet certain household income levels and other requirements you may be eligible for the Premium Assistance Program (PAP). Through this program you will get your health coverage through a commercial health plan called a Qualified Health Plan (or QHP) through the Federally Facilitated Marketplace (FFM)."

IMO
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Re: What's your experience with Medicaid ?

Post by IMO » Sat Dec 02, 2017 3:37 pm

1. Medicaid rates to the provider are not the best. Thus you will find that some facilities/provider accept Medicaid and some may not. Some areas/states may have varying rates on who takes Medicaid, but in some areas the number of individuals on Medicaid may be very high and thus in those areas Medicaid is more likely to be accepted.
2. Medical care is dictated by the "Standard of Care" so if you are provided medical care, the Standard of Care must be met. Thus, it is erroneous to think that one on Medicaid is getting less than the Standard of Care. If one were to not get the Standard of Care, no matter what insurance, that opens the door for medical malpractice.
3. Medicaid from a patient perspective can often be better than other insurances. There are no deductibles for Medicaid while most other insurances have deductibles/co-pays.
4. If you're getting care on Medicaid from a provider and deems you need to see a specialist/get care at the local Emergency Room, that provider will be much happier if you have Medicaid vs. no insurance.
5. States can have different names for Medicaid, and not all Medicaid plans are the same.
6. Medicaid patients, as a general rule, tend to have the least respect for no-showing for scheduled appointments, and even surgical appointments. Such lack of respect can often lead to providers opting to no longer take Medicaid.
7. Medicaid is an extremely expensive program, paid via taxpayers.
8. Medicaid fraud is a significant problem.

There's probably more, but that's what come to thought on "experience with Medicaid."

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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 4:15 pm

8. Medicaid fraud is a significant problem.

What is the source of this fraud? Providers? Recipients? Both?

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Re: What's your experience with Medicaid ?

Post by arcticpineapplecorp. » Sat Dec 02, 2017 4:31 pm

IMO wrote:
Sat Dec 02, 2017 3:37 pm
6. Medicaid patients, as a general rule, tend to have the least respect for no-showing for scheduled appointments, and even surgical appointments. Such lack of respect can often lead to providers opting to no longer take Medicaid.
7. Medicaid is an extremely expensive program, paid via taxpayers.
8. Medicaid fraud is a significant problem.
#6. is a gross generalization about the attitude of those on medicaid, firstly. Secondly, you are attempting to make a causal argument with no evidence, i.e. you're saying the amount of no shows "causes" doctors to no longer take Medicaid. Couldn't it just as easily be the lower reimbursement rate? We must be careful with assumptions we make. In fact, research has shown that in a medicaid experiment in one state (where certain people had access to medicaid and others didn't) the group who suddenly got medicaid began consuming health care MORE, not less, as no shows would suggest. (source: https://www.google.com/search?q=when+pe ... fox-b-1-ab).

#7. Medicare is also an extremely expensive program, paid via taxpayers (source: https://www.google.com/search?q=is+medi ... fox-b-1-ab)...but nobody seems to give medicare the same short shrift they do with medicaid. I wonder why that is? Implicit bias, maybe against those on medicaid, i.e. the poor? The reality is that much of the medicaid spending is on expensive nursing home care no longer covered by medicare. It's not the "welfare queens" most people like to blame who are driving up the costs, but rather Grandma and Grandpa who are getting 24/7 skilled nursing care. That doesn't come cheap.

#8. So while medicaid's fraud accounted for 12% of the overall medicaid spending (source: https://www.google.com/search?q=amount+ ... fox-b-1-ab), Medicare's fraud totaled "more than 10% of medicare's total budget" (source: https://www.google.com/search?q=amount+ ... fox-b-1-ab)
Last edited by arcticpineapplecorp. on Sat Dec 02, 2017 4:39 pm, edited 5 times in total.
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Re: What's your experience with Medicaid ?

Post by sciliz » Sat Dec 02, 2017 4:34 pm

I was on Medicaid in Michigan for my last pregnancy. Overall, the insurance side of things was good. For pregnancy they had a community health center based model for the prenatal care, which happened to be the clinic I had already been taking my older kid to. Then you registered with one of the two local hospitals for delivery.

The good:
-I had a great OB/GYN at delivery. The baby had intra-uterine growth restriction, which meant they had to induce. The Dr. talked me through the many interventions and did an excellent job with the actual delivery part.
-I had a genetic screen test come back with concerning results, and after I asked about it they got me to a genetic counselor effectively. The genetic counselor was also extremely good at her job, and she got me the test I needed (MaterniTI21). If you ask me, they should give everyone who has a positive quad screen a cell free DNA test without having to go through a genetic counselor, as it would be cheaper (the tests are 2k list price), but most people don't have a PhD in molecular medicine, and having the genetic counselor explain things might be useful to some people.
-The high risk pregnancy specialist I saw after the concerning genetic screen was also extremely good at his job, and helped me understand the weird ultrasound findings and the odds.
-Cannot say enough nice things about the anesthesiologist (and epidurals). My first one was all natural, but induction is a whole other ballgame.

The bad:
The basic model gave you a choice, either to see midwives or residents for the early routine care (anything complex getting referred to specialists). I went with the residents because I preferred the hospital they were at, and oh my gosh. Some of them were idiots and I saw oodles of different people. One of them didn't tell me the result of the genetic screen-I had to find it out online, without any guidance in interpreting the results. I feel any delay in getting people those kind of results is unconscionable.
I disliked having so many different providers, but honestly I had the same problem when I had "good" employer based insurance and I was seen at an academic medical system for my first pregnancy. The community health center model can feel very paternalistic, but it is undeniably convenient in some ways. The basic principle of "see the cheapest provider first, and if and when they need to they refer you to the more expensive/specialist care" is not the worst thing.

I did not pay a dime out of pocket for anything, which was amazing.

I also have friends and relatives who used Medicaid in the case of extremely premature infants and medically needy adopted kids. In all cases, there are more than the usual headaches with bureaucracy, but most are experienced when you try to get the care, not after the fact. In contrast, in my experience with employer based private insurance and individual open market insurance, it's easy to get whatever care you like and then you find out after the fact the insurance company doesn't want to pay. If I had to guess, doctors/providers know the low reimbursement rate of Medicaid, and don't facilitate treatments that aren't the obvious routine stuff where there is an economy of scale.

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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 4:52 pm

#6. is a gross generalization about the attitude of those on medicaid, firstly. Secondly, you are attempting to make a causal argument with no evidence, i.e. you're saying the amount of no shows "causes" doctors to no longer take Medicaid. Couldn't it just as easily be the lower reimbursement rate? We must be careful with assumptions we make. In fact, research has shown that in a medicaid experiment in one state (where certain people had access to medicaid and others didn't) the group who suddenly got medicaid began consuming health care MORE, not less, as no shows would suggest. (source: https://www.google.com/search?q=when+pe ... fox-b-1-ab).
I wonder (don't know) if there may be a difference between Medicaid patients and most others in whether a "no show" fee can be charged and/or collected?

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dm200
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Re: What's your experience with Medicaid ?

Post by dm200 » Sat Dec 02, 2017 4:54 pm

#7. Medicare is also an extremely expensive program, paid via taxpayers (source: https://www.google.com/search?q=is+medi ... fox-b-1-ab)...but nobody seems to give medicare the same short shrift they do with medicaid. I wonder why that is? Implicit bias, maybe against those on medicaid, i.e. the poor? The reality is that much of the medicaid spending is on expensive nursing home care no longer covered by medicare. It's not the "welfare queens" most people like to blame who are driving up the costs, but rather Grandma and Grandpa who are getting 24/7 skilled nursing care. That doesn't come cheap.
We have an extremely expensive program (on the one hand) and overwhelming complaints about unfairly low reimbursements for Medicare services. Puzzling..

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Re: What's your experience with Medicaid ?

Post by sciliz » Sat Dec 02, 2017 8:47 pm

dm200 wrote:
Sat Dec 02, 2017 4:54 pm
#7. Medicare is also an extremely expensive program, paid via taxpayers (source: https://www.google.com/search?q=is+medi ... fox-b-1-ab)...but nobody seems to give medicare the same short shrift they do with medicaid. I wonder why that is? Implicit bias, maybe against those on medicaid, i.e. the poor? The reality is that much of the medicaid spending is on expensive nursing home care no longer covered by medicare. It's not the "welfare queens" most people like to blame who are driving up the costs, but rather Grandma and Grandpa who are getting 24/7 skilled nursing care. That doesn't come cheap.
We have an extremely expensive program (on the one hand) and overwhelming complaints about unfairly low reimbursements for Medicare services. Puzzling..
What else could possibly be the outcome for a program whose mandate includes coverage of all babies hospitalized for more than 30 days (institutional Medicaid) as well as nearly all long term care coverage in this country?
5% of people drive 49% of healthcare costs. Medicaid covers many of those, by design. It cannot be designed as luxury subsidies for physicians, nor can it be cheap.

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Re: What's your experience with Medicaid ?

Post by staythecourse » Sun Dec 03, 2017 12:03 am

dm200 wrote:
Sat Dec 02, 2017 4:52 pm
#6. is a gross generalization about the attitude of those on medicaid, firstly. Secondly, you are attempting to make a causal argument with no evidence, i.e. you're saying the amount of no shows "causes" doctors to no longer take Medicaid. Couldn't it just as easily be the lower reimbursement rate? We must be careful with assumptions we make. In fact, research has shown that in a medicaid experiment in one state (where certain people had access to medicaid and others didn't) the group who suddenly got medicaid began consuming health care MORE, not less, as no shows would suggest. (source: https://www.google.com/search?q=when+pe ... fox-b-1-ab).
I wonder (don't know) if there may be a difference between Medicaid patients and most others in whether a "no show" fee can be charged and/or collected?
As far as I know it is illegal to bill a medicaid patient a "no show" fee.

I will say medicaid patients do seem to have a higher no show rate then other insured patients. I am not saying it is because they care less about the doctor's time (that may or may not be true), but language barriers and/ or ride issues is often a problem.

Either way for a private practice doc (who doesn't have to answer to anyone) most if not all good ones don't take medicaid patients due to poor reimbursement, seem to be more disrespectful, and higher no show rates which leads to higher noncompliance to treatment (which is LEGALLY liable to the physician). I know one case the OB said to the patient get x checked out from a consultant multiple times and documented the patient was noncompliant in doing so on multiple visits. In the end they did have a complication from not getting it checked out and later sued and won a multi million dollar lawsuit against doc and hospital system. It is true once you take on the "duty" of physician to the patient insurance does not matter in regards to ethics of medical care, but unfortunately if docs feel a higher liability of taking care of this population ALONG with lower reimbursement it is a simple decision. Higher risk for lower return is not a good investment decision and is usually not a good business decision either.

Good luck.
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Re: What's your experience with Medicaid ?

Post by staythecourse » Sun Dec 03, 2017 12:14 am

dm200 wrote:
Sat Dec 02, 2017 4:54 pm
#7. Medicare is also an extremely expensive program, paid via taxpayers (source: https://www.google.com/search?q=is+medi ... fox-b-1-ab)...but nobody seems to give medicare the same short shrift they do with medicaid. I wonder why that is? Implicit bias, maybe against those on medicaid, i.e. the poor? The reality is that much of the medicaid spending is on expensive nursing home care no longer covered by medicare. It's not the "welfare queens" most people like to blame who are driving up the costs, but rather Grandma and Grandpa who are getting 24/7 skilled nursing care. That doesn't come cheap.
We have an extremely expensive program (on the one hand) and overwhelming complaints about unfairly low reimbursements for Medicare services. Puzzling..
Why is that puzzling? Who says folks aren't making money off medicare services? It is not the physicians though. Go ahead and google medicare fee schedule for the last 10 years and you will not see much if any provider reimbursement go up over this time in REAL terms. In reality, there are many special interest groups keeping medicare costs higher then it needs to be. For example, I do a procedure that cost LITERALLY 2-3x more in the hospital vs. in the office. Does that make any sense? It is the exact same procedure with the exact same equipment with the exact same pair of hands yet the money doled out is 2-3x more? Now you understand why hospitals were so willing to come and agree to the ACA. They were guaranteed HIGHER reimbursement for the same procedure that could be done at a lower cost at an office or surgery center. This ultimately would make doing x procedure unprofitable at a office or surgery center and push that volume of cases to the hospital where the $$$ start. So political admin gets what they want the stamp of approval of a strong special interest group to get their agenda passed and the special interest makes more money. The problem with medicare as MOST government programs is the folks in charge (politicians) are more loyal to the special interest then their constituents who voted for them. Sad, but true.

Good luck.

p.s. Doctors salaries are still great NOT because we make more for doing X, but because we are doing 20% more of x then we did 10 years ago to make the same salary. Not because the reimbursements have decreased just more hard work/ longer hours.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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Re: What's your experience with Medicaid ?

Post by staythecourse » Sun Dec 03, 2017 12:22 am

Got off a tangent, but to answer the OP question. Yes medicaid is fine if you are in an area that has hospitals that employ the primary care and specialists along with the ancillary service lines, i.e. imaging, physical therapy, lab services, etc...

If you have a discerning patient and want control to choose who you want medicaid will limit your choices as most specialists do not take it.

Politics aside if you can't afford better then get the best plan you can afford. Any insurance is better then no insurance. What I would do is call all the facilities and/ or providers you are interested in having take care of you, if any in particular, and make sure they take your insurance BEFORE purchasing it. That, of course, is my advice for anyone thinking about changing insurance. For example, you check and find your primary takes it and you sign up then later find out your kid's pediatrician doesn't and have to switch to a new one that you may not want to just because you didn't check everything out first.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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Re: What's your experience with Medicaid ?

Post by dm200 » Sun Dec 03, 2017 9:47 am

Without getting too far off the path here, on the one hand I believe in expanded access to healthcare - and on the other hand - believe that those with health/medical problems should take responsibility for their health and medical care.

So, whatever your income, insured status, etc. - doing things like not following medical advice, not taking medications, not showing up for appointments, etc. are things that should be (somehow) taken into account. Maybe for such persons (whatever their status) some different kind of health access might be a good idea.

It amazes me, for example, how many folks (of a variety of backgrounds, insured status, etc.) go to the Hospital emergency room so often vs. dealing with health issues on a timely manner with their Physicians.

I my long life, I have only been to a Hospital ER twice in my life - once for me (complete false alarm) and once for our then 12 year old son (tests/scans showed he was ok). Both were miserable and annoying experiences.

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Re: What's your experience with Medicaid ?

Post by dbr » Sun Dec 03, 2017 9:51 am

dm200 wrote:
Sun Dec 03, 2017 9:47 am
Without getting too far off the path here, on the one hand I believe in expanded access to healthcare - and on the other hand - believe that those with health/medical problems should take responsibility for their health and medical care.

So, whatever your income, insured status, etc. - doing things like not following medical advice, not taking medications, not showing up for appointments, etc. are things that should be (somehow) taken into account. Maybe for such persons (whatever their status) some different kind of health access might be a good idea.
For some people I know showing up for medical appointments is not so simply accomplished and part of their problem is the medications they take rather than not taking medications. Maybe you have a point in general, but life is not always so simple. In many cases everything comes down to whether or not a person is lucky enough to have a lay caregiver who donates huge amounts of time and energy to seeing that someone is ok. Institutionalized living is also not a panacea.

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Re: What's your experience with Medicaid ?

Post by dm200 » Sun Dec 03, 2017 10:02 am

dbr wrote:
Sun Dec 03, 2017 9:51 am
dm200 wrote:
Sun Dec 03, 2017 9:47 am
Without getting too far off the path here, on the one hand I believe in expanded access to healthcare - and on the other hand - believe that those with health/medical problems should take responsibility for their health and medical care.
So, whatever your income, insured status, etc. - doing things like not following medical advice, not taking medications, not showing up for appointments, etc. are things that should be (somehow) taken into account. Maybe for such persons (whatever their status) some different kind of health access might be a good idea.
For some people I know showing up for medical appointments is not so simply accomplished and part of their problem is the medications they take rather than not taking medications. Maybe you have a point in general, but life is not always so simple. In many cases everything comes down to whether or not a person is lucky enough to have a lay caregiver who donates huge amounts of time and energy to seeing that someone is ok. Institutionalized living is also not a panacea.
I know a person who (not in late 50's) who received subsidized housing and some degree of public assistance/disability. She is, basically, a good person - but has serious health problems (including Type 2 diabetes) and is almost never happy with healthcare or physicians. I am sure she is a "difficult" patient for whatever provider she deals with. She was with Kaiser Medicare (same plan DW and I are very happy with), but got hell in her and jumped to the conclusion that Kaiser was no good. I think there are some "mental health" issues involved - she sees conspiracy everywhere. I am also sure there are a lot of similar folks - who really need healthcare -- BUT (probably for multiple reasons) are "difficult" for the healthcare system to deal with.

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Re: What's your experience with Medicaid ?

Post by tigerdoc93 » Sun Dec 03, 2017 10:39 am

Sciliz wrote, “I went with the residents because I preferred the hospital they were at, and oh my gosh. Some of them were idiots and I saw oodles of different people. One of them didn't tell me the result of the genetic screen-I had to find it out online, without any guidance in interpreting the results. I feel any delay in getting people those kind of results is unconscionable”

I am an Emergency Physician and I just got home after working a hectic night shift in a busy, chaotic ER. So, I’m a little cranky right now and I can’t let this comment slide. Residents are not idiots! They are extremely smart dedicated individuals that are learning a complex profession in a stress filled demanding environment. They are overworked and underpayed and when they complete their residency many of them are $300,000 in debt. So the next time you feel a resident physician is an idiot b/c they aren’t experts in a particular test maybe you can keep this in mind.

My 2 cents.

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Re: What's your experience with Medicaid ?

Post by dm200 » Sun Dec 03, 2017 11:22 am

tigerdoc93 wrote:
Sun Dec 03, 2017 10:39 am
Sciliz wrote, “I went with the residents because I preferred the hospital they were at, and oh my gosh. Some of them were idiots and I saw oodles of different people. One of them didn't tell me the result of the genetic screen-I had to find it out online, without any guidance in interpreting the results. I feel any delay in getting people those kind of results is unconscionable”
I am an Emergency Physician and I just got home after working a hectic night shift in a busy, chaotic ER. So, I’m a little cranky right now and I can’t let this comment slide. Residents are not idiots! They are extremely smart dedicated individuals that are learning a complex profession in a stress filled demanding environment. They are overworked and underpayed and when they complete their residency many of them are $300,000 in debt. So the next time you feel a resident physician is an idiot b/c they aren’t experts in a particular test maybe you can keep this in mind.
My 2 cents.
When we were first married almost 40 years ago, my wife and I were insured for a year or two under an HMO from her employer. You were not assigned a specific Physician - but the plan was located at or near a University/Hospital with a Medical school. I think (cannot recall details) we would see resident physicians some of the time. During certain months, with the patient's full consent, medical students would take part in the examination - then the "real" doctor would come in. I recall that these encounters with resident physicians were not at all rushed and very thorough.

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Re: What's your experience with Medicaid ?

Post by digarei » Sun Dec 03, 2017 11:30 am

tigerdoc93 wrote:
Sun Dec 03, 2017 10:39 am
I am an Emergency Physician and I just got home after working a hectic night shift in a busy, chaotic ER. So, I’m a little cranky right now and I can’t let this comment slide. Residents are not idiots! They are extremely smart dedicated individuals that are learning a complex profession in a stress filled demanding environment. They are overworked and underpayed and when they complete their residency many of them are $300,000 in debt. So the next time you feel a resident physician is an idiot b/c they aren’t experts in a particular test maybe you can keep this in mind.

My 2 cents.
Please get some sleep.
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Re: What's your experience with Medicaid ?

Post by sciliz » Sun Dec 03, 2017 11:43 am

dm200 wrote:
Sun Dec 03, 2017 9:47 am
Without getting too far off the path here, on the one hand I believe in expanded access to healthcare - and on the other hand - believe that those with health/medical problems should take responsibility for their health and medical care.

So, whatever your income, insured status, etc. - doing things like not following medical advice, not taking medications, not showing up for appointments, etc. are things that should be (somehow) taken into account. Maybe for such persons (whatever their status) some different kind of health access might be a good idea.

It amazes me, for example, how many folks (of a variety of backgrounds, insured status, etc.) go to the Hospital emergency room so often vs. dealing with health issues on a timely manner with their Physicians.

I my long life, I have only been to a Hospital ER twice in my life - once for me (complete false alarm) and once for our then 12 year old son (tests/scans showed he was ok). Both were miserable and annoying experiences.
I believe "those with health/medical problems" consists of virtually every individual, at some point in their life, and "should take responsibility for their health and medical care" is a rather... non-actionable suggestion for premature infants whose hospitalizations cost millions before their first birthdays.

Quasi-relevant to the original post, one of the things I was surprised by with Medicaid was that milage was reimbursable and the particular flavor I had would help you get transportation to your appointments. The no-show rate being higher for Medicaid patients appears to be a real phenomenon, and there are a number of evidenced based approaches for dealing with it.
tigerdoc93 wrote:
Sun Dec 03, 2017 10:39 am
Sciliz wrote, “I went with the residents because I preferred the hospital they were at, and oh my gosh. Some of them were idiots and I saw oodles of different people. One of them didn't tell me the result of the genetic screen-I had to find it out online, without any guidance in interpreting the results. I feel any delay in getting people those kind of results is unconscionable”

I am an Emergency Physician and I just got home after working a hectic night shift in a busy, chaotic ER. So, I’m a little cranky right now and I can’t let this comment slide. Residents are not idiots! They are extremely smart dedicated individuals that are learning a complex profession in a stress filled demanding environment. They are overworked and underpayed and when they complete their residency many of them are $300,000 in debt. So the next time you feel a resident physician is an idiot b/c they aren’t experts in a particular test maybe you can keep this in mind.

My 2 cents.
To be completely clear:
The resident who ordered my quad screen at 14 weeks did not give me the results (consistent with a 1/15 chance of trisomy 21) when they were available (instead I had to find out about them myself via my online chart at 20 weeks), WAS an idiot. I'm not upset she didn't explain the test, I'm upset she didn't ensure the results were communicated. In fairness, when I discussed with administrators at the clinic, it seemed like the tag-team system made it too easy for things in the chart to be missed. Patients AND providers deserve better electronic records.

The resident who happened to be working when I found this out, and had to field my frantic calls about cell free DNA tests and other options, who moved heaven and earth to make sure I could get in to see the genetic counselor FAST, was NOT an idiot. He may have been a saint. He was certainly very bright and very patient.

I have a good feel for what residents go through, and I think in OB in particular we HAVE to ensure they are less overworked. That said, they are still learning how to communicate with patients and sometimes that does not go smoothly. Also, as we have seen in this thread, people have... preconceived notions as to what a "Medicaid patient" is like. And I am a particularly difficult patient to communicate with, unless you happened to have 3-7 peer reviewed journal articles handy when I ask you a question. :twisted:

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