Medicaid............not the "great benefit" you think it is............

[FinanceDude]

All this nationalized health care and Medicaid talk got me thinking about my recently deceased FIL.

He was diagnosed with diabetes in 1978, a year after his wife died. Within 6 years, even on insulin, he slowly got worse and became a brittle diabetic. Because of his disease, he could not do much farming. Because of that, he filed bankruptcy, and a farm that had been in the family for over 100 years was gone.

All of his worldly posessions other than the clothes on his back were sold, and he was in various nursing homes and assisted living facilities for the last 20 years of his life. He was moved several times, often to places that were not as nice because the place he was decided they didn't want Medicaid patients.

I will say he received decent medical care, including a pacemaker and several hospital stays over that time. However, he had NO chocies about where he was able to live, etc. To me, not the ideal life............

I realize he was a "ward of the state", but anyone who thinks Medicaid is the "bomb" should research it more. I recall that he got $40 a month out of his SS payments given to him, the other $1200 went to help pay for his care..........so it wasn't totally "free" care..................

[Rich_by_the_Bay]

Medicaid has never been a pleasant experience for anyone. Haven't yet met anyone who would describe it as a "great benefit" though it is better than nothing. And, yes, as a "ward of the state" freedom of choice disappears.

It is adminstrated by each state and funded from federal sources as I understand it. In practice it has always been the payor of last resort, and qualification criteria virtually guarantee that it will be predominantly populated with patients who are indigent and often impaired.

BTW, Medicaid is a poor predictor of any future universal health insurance IMHO. UHC will likely be funded by both private and government sources, and by definition will cover everyone.

I think Medicare, for all its deficiencies, will have a stronger resemblance to future universal health care proposals. Dangerous to predict in this area, though.

[Jarhead*]

Quote:

Originally Posted by Rich_in_Tampa Medicaid has never been a pleasant experience for anyone. Haven't yet met anyone who would describe it as a "great benefit" though it is better than nothing. And, yes, as a "ward of the state" freedom of choice disappears.

Rich: We have been through Medicaid with my MIL and most recently with my mother. (Both deceased).

It damn sure isn't a pleasant experience, but my wife and I would consider it a "great benefit".

We tried as best we could to avoid it as long as we could. Both of them, at different times were living in our home, and continued until their respective doctors put their foot down and said with all the trips we were making to emergency, etc. that we were on a bad track, and actually forced the issue.

Flash back during a period of time (prior to Medicaid), when my mother, who raised 8 children of her own, spent 5 years doing the best she could to take care of my immigrant grandmother who was stricken with a long drawn out cancer in her home.

Perfect, probably not, but in my opinion it is certainly progress.

From a personal stand-point, with our past experience, it has damn sure been a wake up call on how we approach our obligations to our own kids.

In the past I have "gifted" my kids from time to time, but no more.

Our game plan now is not to put our kids through what we went through.

Big problem, no easy solutions.

[Sandy]

FinanceDude and Jarhead, as you saw from personal experience, Medicaid is an essential safety net program when needed, but no one with a choice would likely go there.

Medicaid is a state/federal partnership specifically designed to care for the most at-risk and brittle in our society:

pregnant women and children - Medicaid pays for nearly 50% of all births in the country based on the idea that getting women into prenatal care will ensure healthier outcomes and protect society as a whole;

aged and frail - Medicaid pays for 60-70% of all nursing home care; and

disabled - including community care for developmentally disabled, and brain and spinal cord injured.

States administer the program and the cost to the state is offset with federal funds. The feds contribution to each state varies, ranging from about 50% to nearly 75% of costs, depending on a complicated formula that assesses each state's "wealth" (a few select services recieve 90% federal funds). To recieve matching funds, the feds require each state to serve certain populations up to certain incomes and to provide certain services. States have great latitude to cover additional populations and to provide additional services. For example, prescription drugs is considered an "optional" service, but of course every state covers this service. In order to receive federal match, state's must get federal approval to serve these "optional" groups and for providing these "optional" services. As a result - if you've seen one Medicaid program,you've seen one Medicaid program - the programs vary greatly from state to state, though have the same core mission.

BTW, Medicaid is not for "the poor". If you don't fit into an at-risk eligibility group, say oyou are merely a poor single male under 65 with diabetes who is not been determined disabled by SSA, you can't get covered.

I agree with Rich, that any UHC will not look like Medicaid, but more likely look like Medicare and will emerge as some type of federal/private partnership. Basic Medicare is limited. Individuals must purchase extra coverage for routine physician services, some hospital costs, and prescription drugs.

[Rich_by_the_Bay]

Quote:

Originally Posted by Sandy Medicaid is a state/federal partnership specifically designed to care for the most at-risk and brittle in our society:

Great post, Sandy. Thanks.

People often misunderstand Medicaid, and even when well-understood all of us who deal with it realize how flawed it is. Even so, it allows care for millions who would otherwise never receive it.

What is the nature of your Medicaid experience/career? You are very knowledgeable.

[Sandy]

Thanks Rich. Let's hope I know something - I do health policy evaluation and develop recommendations for your state - mostly in Medicaid

[Jarhead*]

Quote:

Originally Posted by Sandy Thanks Rich. Let's hope I know something - I do health policy evaluation and develop recommendations for your state - mostly in Medicaid

Sandy: Have a question for you, re: Medicaid if you don't mind.

When my relatives were being evaluated for financial qualifications for Medicad Rest Home information, I remember filling out a long form inquiring about assets. They had none to speak of, possibly $l,000.00 or so.

They didn't own a home. Question is, Medicade didn't ask about home ownership, so is that intended to be excluded on a net worth evaluation?

My understanding is that home ownership is excluded in the evaluation
(qualification) stage, but the indivdual states have the right to the property after the individual passes away. Is that correct.?

Thanks, Sandy

[Sandy]

Jarhead: the answer is not so simple, since if varies from state to state. Florida, excludes assets (equity) in the home if there is a spouse residing there.

Many states are moving to recover funds spent from the estate once everyone passes. For people who want to protect their assets, but still qualify for Medicaid, you generally need an attorney (There are specialists in this area). It gets tricky becuase any liquidation of assets up to 5 years before needing services is considered questionable by Medicaid

[Jarhead*]

Quote:

Originally Posted by Sandy Jarhead: the answer is not so simple, since if varies from state to state. Florida, excludes assets (equity) in the home if there is a spouse residing there. Many states are moving to recover funds spent from the estate once everyone passes. For people who want to protect their assets, but still qualify for Medicaid, you generally need an attorney (There are specialists in this area). It gets tricky becuase any liquidation of assets up to 5 years before needing services is considered questionable by Medicaid

Sandy: Thanks for answering.

I certainly can understand the states stance in recovering funds.

In our personal situations, there was nothing to recover.

My question was a result of a conversation that I had with a friend of mine claiming that a home was "hands-off" for recovery purposes. Didn't make sense to me, and in fact, beings there was not a spouse at the time of his mother entering medical facilities (rest home), my guess (I didn't ask) is that she had deeded property to him prior to entering and becoming "Medical qualified".

Tricky stuff, and if there are assets involved, your advice to consult an "Elder-Care" attorney is good advice.

[FinanceDude]

Quote:

Originally Posted by Sandy Jarhead: the answer is not so simple, since if varies from state to state. Florida, excludes assets (equity) in the home if there is a spouse residing there. Many states are moving to recover funds spent from the estate once everyone passes. For people who want to protect their assets, but still qualify for Medicaid, you generally need an attorney (There are specialists in this area). It gets tricky becuase any liquidation of assets up to 5 years before needing services is considered questionable by Medicaid

And hope you find a GOOD attorney..... I have had a number of "unpleasant" discussions with some "elder attorneys" looking to "hide" assets from the Medicaid folks........... :P :P

[cute fuzzy bunny]

My dad supplements his medicaid with a medigap hmo from kaiser. Pretty reasonable monthly fees (under a hundred bucks). Pays a little $20-30 copay for office visits and whatnot. Then they cover everything like a regular health policy.

He highly recommends it.

[pfpelican]

Quote:

Originally Posted by Cute Fuzzy Bunny My dad supplements his medicaid with a medigap hmo from kaiser. Pretty reasonable monthly fees (under a hundred bucks). Pays a little $20-30 copay for office visits and whatnot. Then they cover everything like a regular health policy. He highly recommends it.

He probably supplements his mediCARE. Very different from mediCAID...as this thread pointed out

[cute fuzzy bunny]

Doh...my mistake. You're right.

[spideyrdpd]

If you join an hmo like kaiser they will get a flat fee from medicaid for your treatment. So its still funding by medicaid.

There are always going to be issues with any kind of insurance. They have to keep costs down to make money. It sucks when keeping costs down effects your medical care.
Considering that they paid for his care for atleast 20 yrs. You should be counting your blessings. Diabetes is a very expensive disease. Although 20 yrs ago they didnt pay for all the supplies. They also had issues with things like transplants. Today the situation still is bad but thousand of times better than what it was.