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Medicaid?
Old 10-29-2013, 10:14 AM   #1
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Medicaid?

Depending on how low your MAGI is, in many states you can land in the medicaid system and apparently pay nothing for coverage. I hear vague bad things about medicaid in many areas. How would one go about finding out how good or bad medicaid is in a specific state or region?
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Old 10-29-2013, 10:22 AM   #2
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No experience with Medicaid, but I hear there's a big problem in states without expanded Medicaid where you can earn too much for Medicaid but earn too little to qualify for subsidized insurance under the ACA.

Also, in states where Medicaid is not expanded, there are usually very low asset limits to qualify. If you had $1 million in the bank and a very low income, you might be expected to spend down $995,000 of it before qualifying.

Beyond that, most likely the biggest concern is the pool of participating doctors and facilities which accept Medicaid.
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Old 10-29-2013, 10:23 AM   #3
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My state has expanded medicaid, so my real concern is adequacy of coverage/services.
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Old 10-29-2013, 10:26 AM   #4
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Have you looked up your state's Medicaid Services web site to see if there's a list of participating providers? Comparing that to (say) a plan on the Exchange could give you a rough idea of the adequacy (or inadequacy) of the "network" of providers that accept Medicaid patients.
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Old 10-29-2013, 11:01 AM   #5
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I don't think Medicaid is ever "bad" other than the stigma attached to it and the fact that you may have to travel some distance for a Medicaid approved doctor (especially if you require a specialist).

I also read that asset tests remain for long term care in expanded Medicaid programs and the ACA did not address the Medicaid Estate Recovery Program. I don't know if either of these things are true.
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Old 10-29-2013, 11:09 AM   #6
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The problem with Medicaid is the reimbursement rate for services. Doctors typically don't go out hunting for new Medicaid patients and many won't accept them. There are some doctors that structure their practice around Medicaid. They need to see a lot of paitents with razor thin overhead to have a chance of making any money. I would hope one of the physicians on the forum would put in their two cents.

One of the concerns in Texas for expanding Medicaid was the availability of doctors. It's one thing for the government to give out "free stuff" but the low payment rate discourages the availability of the supply.
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Old 10-29-2013, 11:31 AM   #7
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The problem with Medicaid is the reimbursement rate for services. Doctors typically don't go out hunting for new Medicaid patients and many won't accept them. There are some doctors that structure their practice around Medicaid. They need to see a lot of paitents with razor thin overhead to have a chance of making any money. I would hope one of the physicians on the forum would put in their two cents.

One of the concerns in Texas for expanding Medicaid was the availability of doctors. It's one thing for the government to give out "free stuff" but the low payment rate discourages the availability of the supply.
We have not yet had a problem with non-acceptance of medicare, and despite living in retirement communities for many years... haven't heard of anyone who has been refused medicaid. FL and IL.

That said... the supply of doctors is limited by the number of authorized medical schools, and the acceptance rate. Depending on how this all shakes out, it will be interesting to see if there will be serious defections from the medicare program. Maybe there is more money in the privately funded system, than I think.
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Old 10-29-2013, 11:56 AM   #8
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We have not yet had a problem with non-acceptance of medicare, and despite living in retirement communities for many years... haven't heard of anyone who has been refused medicaid. FL and IL.
Medicare and Medicaid are two different animals although many doctors in my area are also not accepting new Medicare patients. This was a question we asked when we started seeing our current primary care doctors. They will keep their existing patients but aren't accepting new ones.

I don't run with the Medicaid crowd. The income level to qualify is very low and Texas didn't expand the income level as specified by the ACA. Even at the expanded income level, I doubt I personally know anyone that would qualify.

Our medical education process is the most costly and difficult in the world. It's all based on Depression Era rules designed to restrict the number of doctors. This process would probably have to be reconcilled to meet the ultimate demand for primary care physicians and the more popular specialists.
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Old 10-29-2013, 12:33 PM   #9
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Agreed.
...........................

A step back to doctors... especially primary care and general practitioners. We see a sea change in this, and although we have a GP here in IL, in Florida, many if not most of our residents use what is loosely called "Urgent Care" for almost all primary care services.

This change has evolved over the past 10 years, from a part time doctor, to now... four "resident" doctors, and numerous physician assistants, nurses and aides. All of these doctors have affiliation with the local hospital(s). While it isn't possible to have regular appointments... just wait in line (though the lines rarely go beyond 30 minutes). Our residents, "call" the doctors their Primary Care Physicians, but this is in name only... and the biggest benefit is that all records are accessible for any doctor.
We have similar situation with outlying medical services here in Illinois, though the growth is not as fast as in Florida. Just this year, the major hospital has offered a care center in a local mall... with 24/7 doctors who are primarily affiliated with the hospital. I have been told that this facility will likely see a doubling or tripling of services within the next year.

In both places, the basic charge is $65 to $75... Much less than the $290 to $500 emergency room fees.

The doctors prescribe medications, blood tests and other basic XRay and common test services... and are closely coordingated with ambulance and paperwork for hospital entry.

I am aware that Urgent Care Centers exist in most towns today, however, unless you know exactly what they provide, and what their hours are, it is possible that they may be so limited in ability as to be more of problem than a solution... For instance, our local Walmart has a "clinic", but is staffed only by a retired nurse or even an intern nurses aide, with no ability to offer more than over the counter medications or to refer a person to an emergency room.

Ok for coughs, colds or UTI's but not much beyond. Of course YMMV...
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Old 10-29-2013, 01:04 PM   #10
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The problem with Medicaid is the reimbursement rate for services. Doctors typically don't go out hunting for new Medicaid patients and many won't accept them. There are some doctors that structure their practice around Medicaid. They need to see a lot of paitents with razor thin overhead to have a chance of making any money. I would hope one of the physicians on the forum would put in their two cents....

Per this blog post, the ACA increases Medicaid reimbursement rates:

Quote:
Thanks to the Affordable Care Act, Medicaid reimbursement rates will increase to at least 100% of Medicare rates in the 2013 and 2014 calendar years. The federal government will fund 100% of the difference in cost between what a state’s Medicaid rate was on July 1, 2009 and the applicable Medicare rate...

It is estimated that Medicaid fees will increase by an average of 73% in 2013, but the impact will vary among states
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Old 10-29-2013, 01:10 PM   #11
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I am aware that Urgent Care Centers exist in most towns today, however, unless you know exactly what they provide, and what their hours are, it is possible that they may be so limited in ability as to be more of problem than a solution... For instance, our local Walmart has a "clinic", but is staffed only by a retired nurse or even an intern nurses aide, with no ability to offer more than over the counter medications or to refer a person to an emergency room.

Ok for coughs, colds or UTI's but not much beyond. Of course YMMV...
We have excellent urgent care practices where I live and they have been around for more than 20 years. They can provide x-rays and have a pharmacy. They are open 7 days a week starting at 6am until 8pm.

In most peoples minds they have replaced the urge to run to the emergency room because they can do so much. I was washing the storm insert to my back door and the window slipped and the point stabbed the top of my foot. It left quite a wound and the pain was terrible. I live about 4 blocks from the hospital and 7 miles from the urgent care and the ER never crossed my mind.
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Old 10-29-2013, 01:19 PM   #12
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Per this blog post, the ACA increases Medicaid reimbursement rates:
I must have missed all those TV commercials where doctors were pleading for Medicaid patients to come to them.

I am not up on the economics of Medicaid patients. I do know that neither my wife's or my personal physician accept Medicaid patients. I can only assume that economics are involved. Medicaid fraud does seem very popular since I hear about it reguarly.

In an earlier post I asked for a physician to pop in with a comment about the Medicaid payment issue.
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Old 10-29-2013, 01:28 PM   #13
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Have you looked up your state's Medicaid Services web site to see if there's a list of participating providers? Comparing that to (say) a plan on the Exchange could give you a rough idea of the adequacy (or inadequacy) of the "network" of providers that accept Medicaid patients.
+1

Most states and some counties have referral websites. It's more difficult to find which doctors accept new patients, but the same difficulty exists for the new health care plans on the exchanges, end even existing plans. I would guess that network scope and size are the best rough proxy.
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Old 10-29-2013, 03:00 PM   #14
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2B


I am aware that Urgent Care Centers exist in most towns today, however, unless you know exactly what they provide, and what their hours are, it is possible that they may be so limited in ability as to be more of problem than a solution... For instance, our local Walmart has a "clinic", but is staffed only by a retired nurse or even an intern nurses aide, with no ability to offer more than over the counter medications or to refer a person to an emergency room.

Ok for coughs, colds or UTI's but not much beyond. Of course YMMV...
I have been to several urgent care facilities in Florida & in Pa. . I was always seen by a physician and given excellent care including X-rays , breathing treatments & follow up . They are great for when you need to be seen but do not need an ER .By the way the clinic at Walmart is run by Cox Medical.

CoxHealth - The Clinic at Walmart - Cox Hospital - Springfield, Missouri (MO) - Ozark - Republic - After-hours, walk-in care for minor illnesses and injuries
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Old 10-29-2013, 03:21 PM   #15
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My local walmart no longer has a clinic but it did a few years ago. Next town over they have clinics in walmart and staffed by one of the hospitals there. Walmart appears to be just a location, the clinics are independently owned/operated.

Walmart.com: Pharmacy: Walmart Clinics
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Old 10-30-2013, 02:42 PM   #16
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I must have missed all those TV commercials where doctors were pleading for Medicaid patients to come to them.
Apparently, in Washington state, some of the HI companies are currently narrowing their list of "in network" providers.
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Old 10-30-2013, 02:48 PM   #17
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Here in Pa, I spoke to an insurance broker a few months ago who said Medicaid was a good program, and recommended enrolling in it, if one qualifies.
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Old 10-31-2013, 05:39 PM   #18
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Depending on how low your MAGI is, in many states you can land in the medicaid system and apparently pay nothing for coverage. I hear vague bad things about medicaid in many areas. How would one go about finding out how good or bad medicaid is in a specific state or region?
I Don't have personal experience but from what I have heard from my friends its very hard to sign up as a new patient under medicaid. I live in the sf bay area. One of my friends is a social worker so its her job to help medicaid people get appointments. She told me she called all hospitals/providers within a 75 mile radius for a patient and the shortest waitlist for an appointment was 255 days. Another friend's daughter was on medicaid for about a year and she waited 6 months for a well check appointment to get her vaccinations and almost couldn't start kindetgarten on time. Her mom was so mad and said she is never going on medicaid again. Your experience may vary tho. The providers provided great service to my friend's daughter but there is just a huge wait to get that service
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Old 11-16-2013, 01:18 PM   #19
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Well, I just now completed my online application at Washington Healthplanfinder. It was fairly easy to do and I got an immediate notice that my application had been accepted and that I'll be enrolled in the state Medicaid program (Apple Health) come January at $0 per month. That was quick!

We'll see what quality of healthcare services I'll get on this Apple Health program. I haven't used any of my private HI for the past three years, so I'm gonna go in for a complete physical before my current HI expires. Looks like I'll be saving some $4,000/year in HI premiums. I guess that's the good part.
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