Medicaid frustration

[PinkyandtheBrains.]

Not nice. That's the same thing as the ugly stereotyping that was done towards people.

I apologize, sincerely. You are right that it comes across that way.

 

I've lived on both ends* of the spectrum, living on the "we could be homeless tomorrow" end of the spectrum has really opened my eyes in ways i didn't expect. I considered myself a proponent of social safety nets and welfare. The reality of needing them and using them is so much different than I ever expected.

 

I really do mean, from even my own experiences financially, that when I had more (money) I was able to be "lazy" more often. I could take vacations, time off, self care expenses like pedicures and more. Now that I no longer have financial resources we are unable to do most of those things.

 

I have also found, now that we no longer have financial comforts, if we do those things we are considered lazy or not working hard. Even individuals I know who consider themselves supportive of social safety nets (welfare) judge a day trip to Chicago to meet a friend, or tickets to a movie. Those treats take a lot more planning and effort to make happen vs. when you have even middle class income. And that's assuming you can even make it happen.

 

Heck, if I buy a latte at Starbucks I am judged, and I'm usually using a gift card :/

 

And with all that, I have 100 times better than someone who was born into poverty and prejudice.

 

 

*by both ends I mean "upper middle class" down to "we could be homeless tomorrow".

[PinkyandtheBrains.]

And, like most generalities, it is pretty false. I know several poor people who are poor because they are lazy and content to let other people take care of them (family and government).

 

How do you identify the laziness and contentment with the circumstance?

[Guest]

How do you identify the laziness and contentment with the circumstance?

Through close relationship and a lifetime of conversation.

[goldberry]

Through close relationship and a lifetime of conversation.

There are some people like that. The ones I know, it seems to be a generational issue.

[Guest]

There are some people like that. The ones I know, it seems to be a generational issue.

For sure!! And Grandma, who did a terrible job raising her kids, ends up raising her grandkids and not much better the second time around.

[Χά�ων]

I don't know if I posted what I think should be done.

 

I think all the excess money that is used forcing people to get on medicaid who do not want it and bureaucracy to make sure everyone is doing what they are forced to do and the amount of staffing it takes, complete waste, to spend hours interviewing people and calling their employers even when they said they want to just get off the medicaid, that financial savings could not only improve the medicaid so that it pays more so that providers will take them, but also put in to medical training programs. Just imagine if we could greatly increase our PAs and NPs and bring back the community health programs with easy access for all. Going to school to be a nurse or a PA or NP is costly and because of cost, many able people do not do it. By having more PAs and NPs working in the communities, we would reduce the people who cannot pay and are stuck on medicaid from going to the ER over fevers, ear infections, and such. I know that on medicaid, where I currently live, if I even wanted my children to have a wellcheck up, which would include vaccinations, I would have to come up with the cash to pay. Medicaid has NO ONE on the plan. I knew I had heard people say, when I volunteered (before my youngest was born) that they could not take their children to the doctor because the nearest doctors on medicaid were over an hour away and they didn't have cars let alone the cost of driving to those places. And for people who worked who were on medicaid, they could not afford taking the entire day off to go to the small handful of doctors who are willing to take medicaid patients.

 

For me anyway, my problem is solved and was never a huge problem for ME. I simply called my husband yesterday and said to put the kids on the insurance after all. I do not know what the state intends to do, have no way of knowing as no one at the state offices knows. BUT, I do know we have medicaid through the end of this week for sure and the autism eval is done on Friday so I will get what we needed. Yay! Hopefully anyway. I do not exactly trust them to not screw even this up.

 

BUT, I am hoping to start a letter writing campaign and perhaps see what else I can do to try to make congress people aware of how bad the medicaid system is in this state and about the financial waste going on with it. Having this system be so bad here is an attack on the people least able to speak for themselves.

You were NOT forced onto medicaid. Yoy found yourself in a situation where the luxery of buying insurance for your family was out of reach fianicially. You choose Medicaid.

 

 

You then learned that your preconcieved notions that those using the social safety net were lazy was wrong and they have to work their butts off to keep it and you resent not having everything handed to you, as you assumed happens.

 

Welcome to poverty, American style. Stop the crap.

Edited July 11, 2017 by Χά�ων

[Selkie]

Our total property taxes for our house are about $2500/year. On a 300k house. School taxes are included in the property taxes.

 

I'm envious of those of you with such low property taxes. Our state has the highest median property tax rate and believe me, we don't get much in return for it. Property taxes for our house are $12,000/year (as of now, anyway - they go up every year) and the majority of that amount is for the school district. 

[Χά�ων]

Do your math.

Annual cost of school tax over your time in a single family home/2 kids is what? Here its 6k per year with a 2.9% increase annually. Call it 40 years, and skip the increase, thats $ 240,000 or 120 k per child. Private religious school is about that here. No, you can't do nonreligious private without a scholarship. Those schools here are priced for dual income professionals or movie stars. My dual income professional friends find its not worth the cost, because the dc don't need 13 years for a high school ed, they either grad their dc at 16 or they pay for DE.DE is comparable to private religious high school cost.

 

Instad of 'calling people out' you would be wiser to ask for clarification or invest your time in yourself and learn about money.

Bless your heart, you really are ignorant (as in uneducated) on this topic.

It has been addressed by others but I will clarify. I am talking about high quality secular education. But, hey I am game for religous education if it meets my expectations, so I pulled up the cost for the closest Jesuit high school. 28k/year. Ouch.

 

For fun I put in 40 years of taxes at the current rate and it is still cheaper to pay taxes. I did not seperate out school taxes from all the taxes, nor did I figure in interest on the educational loan I would have to take out. So I assumed I will pay MORE in taxes than I am, and I did not include interest on the loan so the tuition rate was lower.

 

Now, if I were to look at the small Christian schools in the suburbs that offer a subpar education, then still nope. Those schools only go to 8th grade and then I am looking at the pricey high school options. Assuming my kid does not need tutoring to meet the standards for admission. They would.

 

Quality private education is not cheap.

[QueenCat]

I'm envious of those of you with such low property taxes. Our state has the highest median property tax rate and believe me, we don't get much in return for it. Property taxes for our house are $12,000/year (as of now, anyway - they go up every year) and the majority of that amount is for the school district. 

 

Ouch! We do have property taxes on our cars annually as well. Sales tax is around 7% with the local options added on, so not bad. However, our state income tax is the highest we've paid anywhere in recent years. But I cannot fathom $1000/month for property taxes...... unless I had a house hitting 2 million plus.

[Χά�ων]

I'm envious of those of you with such low property taxes. Our state has the highest median property tax rate and believe me, we don't get much in return for it. Property taxes for our house are $12,000/year (as of now, anyway - they go up every year) and the majority of that amount is for the school district.

Our is not that high and the largest chunk is not to the schools.

 

Still 12k will not pay for a year at ine of the quality private schools here.

[Χά�ων]

Ouch! We do have property taxes on our cars annually as well. Sales tax is around 7% with the local options added on, so not bad. However, our state income tax is the highest we've paid anywhere in recent years. But I cannot fathom $1000/month for property taxes...... unless I had a house hitting 2 million plus.

Pretty much this. Rent is not a $1,000/month in some areas here!

[Catwoman]

You were NOT forced onto medicaid. Yoy found yourself in a situation where the luxery of buying insurance for your family was out of reach fianicially. You choose Medicaid.

You then learned that your preconcieved notions that those using the social safety net were lazy was wrong and they have to work their butts off to keep it and you resent not having everything handed to you, as you assumed happens.

Welcome to poverty, American style. Stop the crap.

Actually, if I recall correctly, she never said they were in a position where they couldn't afford health insurance, even when her dh was out of work, so it seems like it really may have been a matter of choice for her family, which makes it even worse that she is complaining so much.

 

I could be mistaken, but I got the impression that they took advantage of Medicaid because it was available to them due to her husband not having any income for a while -- and then I think she started a thread specifically because she was positively livid that they were asking her for personal information in order for her family to qualify for it.

 

I'm not objecting to her family using Medicaid if they needed it -- that's why it's there. I do object to her and her dh being mortified to admit it to anyone, and complaining constantly about a program that has helped her family.

 

(Edited for typos)

Edited July 11, 2017 by Catwoman

[Selkie]

Ouch! We do have property taxes on our cars annually as well. Sales tax is around 7% with the local options added on, so not bad. However, our state income tax is the highest we've paid anywhere in recent years. But I cannot fathom $1000/month for property taxes...... unless I had a house hitting 2 million plus.

 

Yeah, that's one reason why there's been a mass exodus of people moving out of our state (Illinois) in recent years. On top of our sky-high property taxes, the state income tax just got raised to 4.95% and our sales tax is 8.25%. 

[Catwoman]

Ouch! We do have property taxes on our cars annually as well. Sales tax is around 7% with the local options added on, so not bad. However, our state income tax is the highest we've paid anywhere in recent years. But I cannot fathom $1000/month for property taxes...... unless I had a house hitting 2 million plus.

Our taxes are crazy high here in the NYC area, and I would actually be thrilled with paying $1000/month for property taxes. It's ridiculous because it's not like we're getting all kinds of incredible services and amenities for the money.

 

The property taxes on our house in the Midwest, on the other hand, are a little less than $8000/year, and they would be much lower than that if we used it as our primary residence, so we're definitely getting a lot more for our money out there.

[QueenCat]

Our taxes are crazy high here in the NYC area, and I would actually be thrilled with paying $1000/month for property taxes. It's ridiculous because it's not like we're getting all kinds of incredible services and amenities for the money.

 

The property taxes on our house in the Midwest, on the other hand, are a little less than $8000/year, and they would be much lower than that if we used it as our primary residence, so we're definitely getting a lot more for our money out there.

 

Double ouch! I'm now reminded why I look at dh with a crazy look when he mentions job transfer possibilities in certain places. I'd love to live in NYC for a year or two, so much to do, but housing & taxes, oh my!

[maize]

Yeah, property taxes are the only thing bad about Texas. I save 500 dollars a month to pay our tax bill on a 300,000 dollar house. ( Yes, I know we have land but we get an ag exemption, so we only pay a couple hundred for the land. Our house and its 1/2 acre cost the rest of the 6,000 a year.

But no income tax. In a high earning household you'd be paying a lot in state income tax In the majority of the US.

[Alessandra]

Yeah, that's one reason why there's been a mass exodus of people moving out of our state (Illinois) in recent years. On top of our sky-high property taxes, the state income tax just got raised to 4.95% and our sales tax is 8.25%.

 

  

Our taxes are crazy high here in the NYC area, and I would actually be thrilled with paying $1000/month for property taxes. It's ridiculous because it's not like we're getting all kinds of incredible services and amenities for the money.

The property taxes on our house in the Midwest, on the other hand, are a little less than $8000/year, and they would be much lower than that if we used it as our primary residence, so we're definitely getting a lot more for our money out there.

New Jersey generally wins top prize for highest property taxes.

 

https://www.thebalance.com/best-and-worst-states-for-property-taxes-3193328

[Selkie]

  

New Jersey generally wins top prize for highest property taxes.

 

https://www.thebalance.com/best-and-worst-states-for-property-taxes-3193328

 

Sadly, Illinois is even worse than New Jersey when you look at the median rate. 

 

http://www.chicagotribune.com/business/ct-illinois-property-tax-rate-0428-biz-20160427-story.html

 

National median property tax rate = 1.31%

 

Illinois median property tax rate = 2.67%

 

New Jersey median property tax rate = 2.37%

[Wheres Toto]

  

New Jersey generally wins top prize for highest property taxes.

 

https://www.thebalance.com/best-and-worst-states-for-property-taxes-3193328

 

 

yippee for us.   :tongue_smilie:

 

We pay about $6000 a year in property tax but our house assesses pretty low.   

 

We were looking at rentals for oldest dd and you can't even get a studio in a decent area for under $1000/month.

 

ETA:  Oh yeah, we still can't pay for private school with what we pay for property tax, definitely not looking at the school portion.  Maybe some of those people in town with the 8000 square foot houses.  But even those people go to our local public high school because it's just that good.

Edited July 12, 2017 by Where's Toto?

[Alessandra]

Sadly, Illinois is even worse than New Jersey when you look at the median rate.

 

http://www.chicagotribune.com/business/ct-illinois-property-tax-rate-0428-biz-20160427-story.html

 

National median property tax rate = 1.31%

 

Illinois median property tax rate = 2.67%

 

New Jersey median property tax rate = 2.37%

Well, it probably depends on a lot of factors -- such how properties are assessed, as well as the percentage.

 

I am going to stand up for NJ being the worst state. Not just that I've read that multiple places, but I live here. Awful property taxes, just awful. NJ went through a thing a hundred years ago or so, called ''boroughfication," I think. Each two-bit village became its own political entity, with its own mayor, police, school district, $$$$$. No efficiency, no sharing.

 

But I don't want to fight with you for last place if you are equally miserable in Illinois. On the contrary, I can commiserate with you. Maybe we can share the lowest rank, lol?

 

I thought NJ had the worst credit rating -- it's falling fast -- but Illinois looks worse.

 

https://comm.ncsl.org/productfiles/83453001/2016_Prunty_Presentation.pdf

Edited July 12, 2017 by Alessandra

[AmandaVT]

I'm envious of those of you with such low property taxes. Our state has the highest median property tax rate and believe me, we don't get much in return for it. Property taxes for our house are $12,000/year (as of now, anyway - they go up every year) and the majority of that amount is for the school district. 

 

Yup, I'm jealous of some of the property tax amounts I've seen posted! We live in a very small house and it's worth maybe $120k and our property tax bill this year is over $2500. For that, we get our road maintained and school. No town water or sewer. 

 

I have friends in nicer houses than ours paying well over $10k a year.

[TechWife]

Why should I supply any information regarding my insurance to them, or income, or anything, after I said I want to cancel the medicaid, if you do not have to? I said in my post that I told them I want to cancel the medicaid and they said they had to contact my husband's employer then. SO, if I have to give them the right to call and discuss us with my husband's employer in order to NOT have medicaid, why shouldn't you have to?

They probably have to document your exit from the program and the reason for it. Doing so is a protection against discrimination as well as financial accountability of the Medicaid program to the taxpayers. They need to, from an ethical standpoint, be able to prove that everyone who qualifies for the coverage gets it if they want it. They also need to be able to prove they aren't systematically or randomly kicking people out of the program for invalid reasons.

[Janeway]

Also, just curious Janeway... you are saying no one takes Medicaid, but you have a children's hospital with an autism evaluation program within 45 minutes.  There is a children's hospital but no general doctors or pediatricians?  That seems kind of odd.

Correct. The children's hospital actually has a pediatric practice in my town that takes medicaid, but only for existing patients. You need to start with them while on private insurance.

[Χά�ων]

Correct. The children's hospital actually has a pediatric practice in my town that takes medicaid, but only for existing patients. You need to start with them while on private insurance.

 

You are saying that child who only has medicaid who need to be followed by the specialists at the childrens hospital for regular care would be turned away unless they first had private insurance?

 

I find this very hard to belive.

 

As a parent of a child with chronic health issues, as a former advocate for special needs, as someone who has gotten exemptions to take her child to a specialist in a different state at a hospital that does not officially take our stayes medicaid, I find this very hard to believe.

[Mergath]

You are saying that child who only has medicaid who need to be followed by the specialists at the childrens hospital for regular care would be turned away unless they first had private insurance?

 

I find this very hard to belive.

 

As a parent of a child with chronic health issues, as a former advocate for special needs, as someone who has gotten exemptions to take her child to a specialist in a different state at a hospital that does not officially take our stayes medicaid, I find this very hard to believe.

 

Yeah, that doesn't make sense to me either. I think someone got their wires crossed somewhere. I can't imagine what the rationale behind this could possibly be.

[Catwoman]

Correct. The children's hospital actually has a pediatric practice in my town that takes medicaid, but only for existing patients. You need to start with them while on private insurance.

I'm certainly no expert on this issue so please forgive me if I sound clueless, but if a child is covered by Medicaid, there is probably at least some chance that he or she was never privately insured. Are you saying that children who have always qualified for Medicaid could never be treated at that children's hospital or hospital-based pediatric practice?

 

That makes no sense to me at all.

[Χά�ων]

I'm certainly no expert on this issue so please forgive me if I sound clueless, but if a child is covered by Medicaid, there is probably at least some chance that he or she was never privately insured. Are you saying that children who have always qualified for Medicaid could never be treated at that children's hospital or hospital-based pediatric practice?

 

That makes no sense to me at all.

Throw in all the children in the foster care system.

[TeenagerMom]

Yeah, that doesn't make sense to me either. I think someone got their wires crossed somewhere. I can't imagine what the rationale behind this could possibly be.

 

 

I'm certainly no expert on this issue so please forgive me if I sound clueless, but if a child is covered by Medicaid, there is probably at least some chance that he or she was never privately insured. Are you saying that children who have always qualified for Medicaid could never be treated at that children's hospital or hospital-based pediatric practice?

 

That makes no sense to me at all.

 

 

More than likely, the issue is that you have to have a PCP assigned for Medicaid.  If that practice is already full with Medicaid patients, they likely will not take NEW Medicaid patients unless that patient was already an established patient prior to getting on Medicaid.  Like when my kids lost their insurance due to my hours being cut at work, their Pediatrician's office went ahead and added them as patients for their Medicaid even though they had no open slots for Medicaid patients because of how many they are contracted for.  Around here, you have to get up at 6 a.m. and call to get a PCP assigned if you want a well sought after Pediatrician (note, there are NO Pediatric practices here that do not accept Medicaid).   There are other PCPs always available at the teaching hospital's practice, but most people don't want to go there because they would rather be at the private practices.

 

 

Edited July 13, 2017 by TeenagerMom

[Jean in Newcastle]

I have no experience with Medicaid but quite a bit with children's hospitals. Because children's hospitals tend to be regional there is a lot of demand for their services. So getting in to see one of the children's doctors has included a lot of triage to determine how urgent the need is, in my experience. That said, our children's hospitals do have urgent cares attached that will take less complicated cases immediately. But again, I don't know about the Medicaid aspect.

 

 

Sent from my iPhone using Tapatalk

[MedicMom]

I tried to get DS on an autism Medicaid waiver. I gave up and left him on our private insurance once I discovered that none of our local doctors were accepting new Medicaid patients. While he could have stayed with our PCP because he was an existing patient, but if she left or quit we'd be stuck.

 

I don't know about doctor billing, but I know with the ambulance we get paid significantly less by Medicaid than we would if the exact same patient had private insurance. I suspect that's why the doctors only take a certain number of patients on Medicaid.

[mom2scouts]

We had Medicaid for a short period of time when dh was unemployed/underemployed and we couldn't use it because we couldn't find a doctor who was taking new Medicaid patients. We would get assigned a PCP, call them and ask for an appointment, and they would tell us they weren't accepting new Medicaid patients. We tried to change our PCP, but none of the doctors would take us, so we could never get established as patients. If we had a severe injury or illness, the only option would have been urgent care or the ER. Let's stop pretending that health INSURANCE is the same thing as health CARE.

[Tap]

I'm certainly no expert on this issue so please forgive me if I sound clueless, but if a child is covered by Medicaid, there is probably at least some chance that he or she was never privately insured. Are you saying that children who have always qualified for Medicaid could never be treated at that children's hospital or hospital-based pediatric practice?

 

That makes no sense to me at all.

 

No true.  Life situations change. Jobs and insurance availability change.   Also qualifying guidelines change.  People relocate and change states. We have lots of patients who go on and off of Medicaid due to job/income changes. 

 

DD18 just qualified for medicaid due to her qualifying this year (paid her own taxes).  She has my private insurance and Medicaid for a secondary.  She hasn't had ever had state Medicaid insurance before. She has a chronic health condition and we pay many thousand out of pocket each year for her care. Medicaid will pay that portion for her now.  

 

Her pediatrician doesn't accept new patients who only have Medicaid. He will continue to take her because she has both....if she looses her private insurance and only has Medicaid, he will still accept her because she is an existing patient. 

[Catwoman]

No true. Life situations change. Jobs and insurance availability change. Also qualifying guidelines change. People relocate and change states. We have lots of patients who go on and off of Medicaid due to job/income changes.

 

DD18 just qualified for medicaid due to her qualifying this year (paid her own taxes). She has my private insurance and Medicaid for a secondary. She hasn't had ever had state Medicaid insurance before. She has a chronic health condition and we pay many thousand out of pocket each year for her care. Medicaid will pay that portion for her now.

 

Her pediatrician doesn't accept new patients who only have Medicaid. He will continue to take her because she has both....if she looses her private insurance and only has Medicaid, he will still accept her because she is an existing patient.

Sorry if my post wasn't clearly worded -- I meant that some children have always been covered by Medicaid, so I was confused by the requirement Janeway mentioned which said that those children wouldn't be able to get a primary care doctor unless they were already covered by private insurance. I do understand that people go on and off Medicaid and may be covered by private insurance at some times and not at other times, depending on their life circumstances.

 

I was just surprised to hear that none of the pediatricians at Janeway's children's hospital practice will accept a child on Medicaid as a patient, but that the child must have been a privately insured regular patient of that practice before the doctors will accept Medicaid. It seems so unfair that not a single doctor in that hospital practice will accept a new patient who is already on Medicaid. :(

[Audrey]

Sorry if my post wasn't clearly worded -- I meant that some children have always been covered by Medicaid, so I was confused by the requirement Janeway mentioned which said that those children wouldn't be able to get a primary care doctor unless they were already covered by private insurance. I do understand that people go on and off Medicaid and may be covered by private insurance at some times and not at other times, depending on their life circumstances.

 

I was just surprised to hear that none of the pediatricians at Janeway's children's hospital practice will accept a child on Medicaid as a patient, but that the child must have been a privately insured regular patient of that practice before the doctors will accept Medicaid. It seems so unfair that not a single doctor in that hospital practice will accept a new patient who is already on Medicaid. :(

 

You aren't confused.  The story doesn't add up, so let's all stop tap dancing around it and call the bullshit bullshit.

Edited July 13, 2017 by Audrey

[eternalsummer]

There are doctor's offices that accept new private insurance patients, but not new Medicaid patients.

 

Therefore, a kid could have been a patient at the clinic if he was at one point on private insurance, because the clinic would have added him as a new patient then, and when he switches to Medicaid he's already a patient there and so they keep him.

 

But if he has only ever had Medicaid, he can't ever get added, as the clinic is not accepting new Medicaid patients (and presumably has not done so for a long time).

[cjzimmer1]

I was just surprised to hear that none of the pediatricians at Janeway's children's hospital practice will accept a child on Medicaid as a patient, but that the child must have been a privately insured regular patient of that practice before the doctors will accept Medicaid. It seems so unfair that not a single doctor in that hospital practice will accept a new patient who is already on Medicaid. :(

 

Around here the doctor don't really get to make those kinds of choices.  The doctors typically work under an established clinic.  The clinic decides if it will take Medicaid or not and under what conditions.  Now the doctors may get a a voice in how the clinic decides or they may not, I'm not really sure how that part works but an individual doctor doesn't get to say yeah I'll take Medicaid if the clinic has voted no. They have to establish their own individual practice to have that control and those are pretty much nonexistent here. So yeah, I can see the all or none scenario on doctors taking medicaid patients.

[Tap]

Sorry if my post wasn't clearly worded -- I meant that some children have always been covered by Medicaid, so I was confused by the requirement Janeway mentioned which said that those children wouldn't be able to get a primary care doctor unless they were already covered by private insurance. I do understand that people go on and off Medicaid and may be covered by private insurance at some times and not at other times, depending on their life circumstances.

 

I was just surprised to hear that none of the pediatricians at Janeway's children's hospital practice will accept a child on Medicaid as a patient, but that the child must have been a privately insured regular patient of that practice before the doctors will accept Medicaid. It seems so unfair that not a single doctor in that hospital practice will accept a new patient who is already on Medicaid. :(

I agree!

 

I think that sometimes the clinics are trying to pressure Medicaid into paying more.  If every office in an area refuses to take Medicaid, it gives them more leverage to  negotiate higher paying contracts. Medicaid undercuts many practitioners to the point that they won't accept it. That is why there are so few PCP doctors who accept Medicaid patients as new patients.  They need a balance of private insurance and medicaid to make sure they are bringing in enough revenue.  Sometimes, a new PCP to the area will take new Medicaid patients to build a patient list, but once they are filling up, they taper off or stop taking Medicaid all together. Not because they are heartless, but because they are a for profit business and Medicaid doesn't pay well. 

 

In pharmacy, Medicaid pays so little on most meds, we actually Lose money to fill them.  We often see profits on a script that are under a dollar.  Literally, 25 cent profits and sometimes even negative ones! That doesn't even pay for a bottle, the labor and overhead to fill the script.  Businesses do it, so that same customer will buy other things while they are waiting for a prescription.  That is where they are making the money. On the cough drops, chicken soup, band aids and soda.  Obviously, doctors don't have that "bonus sale". 

[Tap]

Around here the doctor don't really get to make those kinds of choices.  The doctors typically work under an established clinic.  The clinic decides if it will take Medicaid or not and under what conditions.  Now the doctors may get a a voice in how the clinic decides or they may not, I'm not really sure how that part works but an individual doctor doesn't get to say yeah I'll take Medicaid if the clinic has voted no. They have to establish their own individual practice to have that control and those are pretty much nonexistent here. So yeah, I can see the all or none scenario on doctors taking medicaid patients.

That may vary by state.  In Washington, it is very, very common to see different doctors in practices from very small, to very large that take different state plans.  There are 4 common plans in our area.  2 of my kids have private and state insurance.  When we recently made a change in PCP (ours relocated), I called ahead to our existing practices to find out which doctors took which plan before we made a decision on which insurance to take.  

 

We use two practices. One is a small doctor owned practice with less than 10 doctors.  They had to tell me doctor by doctor which Medicaid plans each took.   It wasn't across the board.  The doctors who had heavy case loads took only one plan, but the new MD took them all.  The other doctors had varying plans accepted. 

 

The other practice we use, is a huge practice that crosses state lines and has almost every specialty possible.  They have multiple hospitals and my guess, close to 1000 doctors/PA/ANRP etc.  Each one, chooses which plans they will take and the parameters around that.  

 

Even at OHSU, a teaching hospital.  Some doctors take state insurance some don't. The hospital will write off remaining balances on patient accounts if the doctor isn't signed up for a state plan.  We run into it all the time. and have never ever had a bill on my kids accounts which have state insurance. 

[Zinnia]

Most pediatricians here operate like this, too.  If an existing patient gets Medicaid suddenly, they will accept it, but they do not accept new patients with Medicaid.  People with Medicaid are expected to go to clinics which may or may not take appointments.  We have a local charity hospital that does not take appointments.  The care you get is fine, but it's awful demoralizing to have to pack a lunch when you take your kids for a sick visit because you don't know if it will take 8 hours to be seen.

 

When a physician is just opening her/his practice, they often take Medicaid, and that's a time people can get into the practice as a patient.  After there are a certain number of Medicaid patients, they do not take anymore new ones.  

 

This is fairly standard here in PCP, pediatrics, and OB.  Medicaid does not pay well in my state.  It often doesn't cover the cost of services (in OB, for instance, it used to pay $1500 for all prenatal care, delivery, and postpartum, in a time that private insurance paid around $4500---this was years ago).  Thus, limiting the percentage of the practice relying on it.  

 

 

[Tree Frog]

I agree!

 

I think that sometimes the clinics are trying to pressure Medicaid into paying more.  If every office in an area refuses to take Medicaid, it gives them more leverage to  negotiate higher paying contracts. Medicaid undercuts many practitioners to the point that they won't accept it. That is why there are so few PCP doctors who accept Medicaid patients as new patients.  They need a balance of private insurance and medicaid to make sure they are bringing in enough revenue.  Sometimes, a new PCP to the area will take new Medicaid patients to build a patient list, but once they are filling up, they taper off or stop taking Medicaid all together. Not because they are heartless, but because they are a for profit business and Medicaid doesn't pay well. 

 

In pharmacy, Medicaid pays so little on most meds, we actually Lose money to fill them.  We often see profits on a script that are under a dollar.  Literally, 25 cent profits and sometimes even negative ones! That doesn't even pay for a bottle, the labor and overhead to fill the script.  Businesses do it, so that same customer will buy other things while they are waiting for a prescription.  That is where they are making the money. On the cough drops, chicken soup, band aids and soda.  Obviously, doctors don't have that "bonus sale". 

 

BIL is a doctor and has said he can't afford to take very many medicaid patients for this reason. If he takes too many, he won't make enough money to pay his staff and overhead. The other problem he has is that medicaid doesn't pay him in a timely manner. He may have to wait 6 months before he's paid for a patient he saw, which makes it more difficult to know what payments are coming in to cover labor and overhead. Logistically, it's also difficult to track the payments for the medicaid patients he sees and it requires more labor because he has to pay someone to track those payments.

[wonderchica]

Access to care varies so widely across the country; for private insurance and government insurance (Medicaid, Medicare, Tricare, VA, etc.). 80% of my clients have Medicaid. I have never heard of any of them being unable to be seen by a local pediatrician or specialist of any kind, including large children's hospitals. I don't live in a rural area but it is also not a large city.

[Insertcreativenamehere]

My son has Medicaid due to disability​ and for most of his five years, it's been his only insurance. He sees numerous specialists, has had innumerable surgeries and hospitalizations and requires quite a bit in terms of medical equipment and ongoing supplies. Never once have we had an issue with not getting care because of his insurance. We pay a hefty parental fee to access Medicaid but it's well worth it since his needs are so extensive.

 

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[Reefgazer]

I would keep the appointment and make monthly payments to the hospital until it's paid off if you are presented with a huge bill.

On our previous insurance, we spent years on various waiting lists trying to get him an evaluation. With the medicaid, the children's hospital took it, which had people who do this type of evaluation. So, we begged and pleaded with them to get him in quickly on the medicaid for an eval. Now, he finally has the eval, in July. IF we cancel these appointments, we will have to go back to the bottom of the wait list and it might not even be covered by the insurance again. We have been waiting years for this. Having this eval is the only silver lining in all this. However, where we live, no family doctors or pediatricians or pharmacies or otherwise take medicaid. I am driving him 45 minutes away to a specialist who is through the children's hospital that takes medicaid. Since he is 13 yrs old now, even if the new insurance allows the children's hospital, the wait lists are 3 years and up. He would age out before he gets in. So the attempts to get an eval will be over. The children's hospital ages out any new patients at 16 yrs old. IF you are already a patient there, you can go to them until 21 yrs old. 

 

Since he has already had multiple appointments and only has one left, I do not want to terminate testing. It is not like he can just go under the new insurance. Besides, the new insurance has not even kicked in yet. So we cannot even get on the wait list until we have the new cards. 

 

[Χά�ων]

My son has Medicaid due to disability​ and for most of his five years, it's been his only insurance. He sees numerous specialists, has had innumerable surgeries and hospitalizations and requires quite a bit in terms of medical equipment and ongoing supplies. Never once have we had an issue with not getting care because of his insurance. We pay a hefty parental fee to access Medicaid but it's well worth it since his needs are so extensive.

 

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This is my experience.

[Χά�ων]

I would again like to point out that children in foster care are on Medicaid. If no providers take medicaid than thousands and thousands of children are going without medical care. This is simply not the case.

[airforcefamily]

deleted since differences of opinion are not welcome here

Edited July 13, 2017 by airforcefamily

[Caroline]

I don't want to come off as heartless saying this because I do feel bad that individuals have to deal with it but, on the whole, I support making public assistance uncomfortable. Just recently new work requirements have reduced the number of people on food stamps. WIC enrollment is down since parents don't want to sit in a waiting room for a couple hours, answer tons of questions, and make their kids get a finger poke for $35 worth of basic foods per month (enrollment is down so much that military bases are closing wic clinics). When it's unpleasant to use only people who really need it will sign up.

Or people who really need it no longer have access and now we have a bunch more hungry children.

[Carol in Cal.]

I would again like to point out that children in foster care are on Medicaid. If no providers take medicaid than thousands and thousands of children are going without medical care. This is simply not the case.

How do you know this?

It seems a bit presumptuous, particularly with all of the evidence to the contrary and the demonstrated differences from region to region in this thread.

 

I entirely believe that there are a ton of children in this country who are going without medical care.

[Carol in Cal.]

I don't want to come off as heartless saying this because I do feel bad that individuals have to deal with it but, on the whole, I support making public assistance uncomfortable. Just recently new work requirements have reduced the number of people on food stamps. WIC enrollment is down since parents don't want to sit in a waiting room for a couple hours, answer tons of questions, and make their kids get a finger poke for $35 worth of basic foods per month (enrollment is down so much that military bases are closing wic clinics). When it's unpleasant to use only people who really need it will sign up.

'Sit in a waiting from for a couple hours'--during working hours?  So that they lose their jobs?  During school hours?  So that their kids miss school and they have to deal with a truancy notice?

 

It's really not as simple as you picture it.

 

There is the difficulty with transportation (well-documented, for instance, in "Evicted"), and there is also the trade off between jeopardizing your job and hence your housing for food assistance, or focussing on housing and hoping that private charity or belt-tightening will make up for the food needs.

 

I think you should look into this further before you draw your conclusions.

 

Besides, we are PAYING FOR these barriers to entry, and I suspect that it would be more financially efficient to pay for more assistance than to pay to make it harder to receive.  But I don't know that for a fact.

Edited July 13, 2017 by Carol in Cal.

[Mergath]

I don't want to come off as heartless saying this because I do feel bad that individuals have to deal with it but

 

Then perhaps you should have stopped right there.

 

Extra irony points for the fact that there are low-ranking people in the military who are on some form of assistance. I guess you also think they don't work hard enough and should be made "uncomfortable" in order to access the help they need?