The truth about Medicaid - for anyone who thinks it still exists. [View All]

[FormerRepublican]

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.