What is the current Republican position on this?

Newtons Bit said:
Like a hospital justifying the massive expense of its newest MRI machine by pressuring its doctors into ordering questionable scans?
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Like that. MRI scanners have been shown to rarely be more effective than cheaper scanning machines. Increased bureaucracy due to tons of insurance firms is another significant factor. Lack of coverage for everyone also contributes by increasing disease incidence and also increasing the premiums for everyone else (through more disease, less money incoming, and having to cover the uninsured in emergencies).
 
eeyore1954 said:
This not true the destitute would qualify for Medicare
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my brother is destitute and mentally ill. he cannot work. he was dropped by medicaid. his meds are $600/monthly. his caseworker does not answer the phone and will not call him back.

luckily he gets assistance from one of the pharmaceutical companies, because otherwise he would be totally screwed.
 
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Newtons Bit said:
Like a hospital justifying the massive expense of its newest MRI machine by pressuring its doctors into ordering questionable scans?
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This also is bad for the hospital itself, because if an insurance company requests medical records to confirm the validity of a claim, and that MRI isn't medically necessary, you're not getting screwed.

But insurances aren't always going to do that, so a hospital can get away with ordering unnecessary MRIs.

You have to be a pretty crappy hospital to be doing that though (though it certainly is a problem). At a reputable hospital, you'll have a specific department set up which reviews all patients who are receiving MRIs as well as their medical policies to make sure the MRI is medically necessary and falls within their policy guidelines.

Also, it's not generally as easy to get fraudulent MRIs as people think, because the vast majority of insurance companies require prior authorization. You have to tell the insurance first that a patient is getting an MRI and submit clinical documentation to support the scan, and the insurance has to approve it after validating medical necessity.

Of course, there have been cases in which clinics have been found to be faking medical records in order to justify scans so they can scam insurances, so if you're just out to defraud an insurance, there are ways to do that.

But there is no prior authorization process with Medicare. You just have to follow their guidelines. Now if you don't, and Medicare asks you for clinical documentation after receiving a claim, you're screwed. But a lot of scans just fall through the cracks and get paid out by Medicare even though they weren't really necessary. So then you end up with Medicare paying for unnecessary scans.

I think Medicare needs more oversight. They need more people employed to review claims more carefully to prevent fraudulent payouts, or payouts for unnecessary services that could have been done by cheaper alternatives. But of it's very hard to convince a company or organization that they will decrease costs by hiring more people. Also, the American mentality is generally that more beaurocracy and more regulation is always a bad thing.
 
joobie said:
my brother is destitute and mentally ill. he cannot work. he was dropped by medicaid. his meds are $600/monthly. his caseworker does not answer the phone and will not call him back.

luckily he gets assistance from one of the pharmaceutical companies, because otherwise he would be totally screwed.
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Why was he dropped from medicaid?
 
BenBurch said:
You'd be amazed at how hard it is to remain on medicaid. They will take a determination that you are a few percent less disabled than you were to cut it off totally, no matter what medical reality is. This is one of the ways the current system sucks.
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Another big problem is for people who don't have consistant wages. My sister used to work for a catering company and she was eligible for Medicaid. However, during the Christmas holidays they were really busy, and for the month of December, her wages went way up (even though they then plummeted after New Years). Medicaid dropped her because she made too much that one month and they considered that her new income, and then she had to reapply to get back on it, which took quite some time. Luckily she wasn't sick, so she wasn't affected by her gap in coverage, but for someone who needs regular care, that's a big problem.

One thing I'll never argue is that Medicare and Medicaid are some kind of perfect, magical alternative to privatized health care. They are fraught with their own problems as well that really need to be resolved, especially if we were to transition to some kind of universal coverage program.

Also, as you said Joobie, Medicaid offices are horribly understaffed, and that's been true with pretty much all state Medicaid programs I've worked with. It is often incredibly difficult getting in touch with case workers and getting call backs from them to resolve any problems.

As with Medicare, my biggest problem with Medicaid is that they do not have enough people working for them to handle the workload.
 
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joobie said:
he doesn't know, and like i said before, his caseworker ain't answering. he has consistent wages: $0.
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Joobie,
A lot of times when Medicaid recipients get dropped and they don't know why - if there's been no change in their condition or income, it's because there was some paperwork they needed to fill out that they didn't return, like an eligibility review form - a form that Medicaid sends to patients where they have to verify demographics and other information.
The problem is that patients typically aren't advised by phone to expect their review form. A lot of people throw them out by accident thinking it's junk mail or just a statement from Medicaid. Also, some people never get them in the first place even though Medicaid says it was sent out.

Another possibility is that a patient is suddenly put on a spend down that they didn't have before due to a change in Medicaid policy. Basically, a spend down works like a deductable. Medicaid will say you have to spend "X" dollars over a given amount of time on medical expenses first before their Medicaid will become active, and before a patient has met their spend down, their Medicaid will show them as disenrolled. However, if your brother has absolutely no income, it is unlikely he'd be put on a spend down.

I would advise that your brother try calling the general Medicaid phone number rather than just trying to call the case worker, and ask to speak to a supervisor. Also, is he seen at a major health care facility - a large community health center or a hospital? Then he could ask to speak with the financial counseling office and they may be able to help get him some answers. They also may be able to help with some drug assistance in the meantime if he's going without his meds.


If not, I'd suggest that he contact his state Representative's office. They can be a great resource for resolving Medicaid problems.
 
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thanks for the advice! i will pass it along to him and my mother.

he is currently only seen at a neighborhood mental health center, and since he lives in the surrounding area his insurance status is thankfully not an issue - they will see him without charge (due to his income).
 
joobie said:
thanks for the advice! i will pass it along to him and my mother.

he is currently only seen at a neighborhood mental health center, and since he lives in the surrounding area his insurance status is thankfully not an issue - they will see him without charge (due to his income).
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No problem. Feel free to PM me as well regarding advice with Medicaid or other resources.
 
Three years ago, while I was unemployed, I applied for Medicaid and was told by the social worker that there was no way a male with no children under age 45 was getting it regardless of income (or the complete lack of) unless I had a disability.
 
Schrodinger's Cat said:
Another big problem is for people who don't have consistant wages.
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In fact, that becomes a real problem in social work. You have sick people you are trying to get back into working as they are able, but they cannot take some jobs because they would end the essential medical coverage while not paying even remotely enough to pay for care out of pocket and not providing any insurance.

In addition, small businesses which have insurance for their workers are often unwilling to take on people who are ill as full-time employees because of what it would do to the rate in the small risk pool such a business represents.

So the system makes it hard for people to climb out of it by creating a huge uncovered gap the sick cannot make it across.

A true universal single-payer system covering 100% of all Americans would not have these problems, would help people remain in the workforce, and would increase the tax rolls.
 
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Travis said:
Three years ago, while I was unemployed, I applied for Medicaid and was told by the social worker that there was no way a male with no children under age 45 was getting it regardless of income (or the complete lack of) unless I had a disability.
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You must have gotten someone who had no clue what they were talking about. Gender should have nothing to do with it. Family size does.
 
eeyore1954 said:
You must have gotten someone who had no clue what they were talking about. Gender should have nothing to do with it. Family size does.
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http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalEligibility.aspx

If you are enrolled in one of the following programs, you can get Medi-Cal:

SSI/SSP
CalWorks (AFDC)
Refugee Assistance
Foster Care or Adoption Assistance Program
In-Home Supportive Services (IHSS)

You can also get Medi-Cal if you are:

65 or older
Blind
Disabled
Under 21
Pregnant
In a skilled nursing or intermediate care home
On refugee status for a limited time, depending how long you have been in the United States
A parent or caretaker relative or a child under 21 if:

The child's parent is deceased or doesn't live with the child, or
The child's parent is incapacitated, or
The child's parent is under employed or unemployed

Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)
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So, no explicit gender component but males cannot be Pregnant or have cervical cancer. (Though the male breast cancer rate is higher than people realize.)
 
BenBurch said:
In fact, that becomes a real problem in social work. You have sick people you are trying to get back into working as they are able, but they cannot take some jobs because they would end the essential medical coverage while not paying even remotely enough to pay for care out of pocket and not providing any insurance.

In addition, small businesses which have insurance for their workers are often unwilling to take on people who are ill as full-time employees because of what it would do to the rate in the small risk pool such a business represents.

So the system makes it hard for people to climb out of it by creating a huge uncovered gap the sick cannot make it across.

A true universal single-payer system covering 100% of all Americans would not have these problems, would help people remain in the workforce, and would increase the tax rolls.
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You speak the truth, good sir. I have seen people in the exact situation you describe. They genuinely want to work again, but if they start working, they lose Medicaid, and the new job either doesn't have insurance or doesn't pay enough to cover the out of pocket expenses. It's a really terrible position to be put in.

BenBurch said:
http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalEligibility.aspx



So, no explicit gender component but males cannot be Pregnant or have cervical cancer. (Though the male breast cancer rate is higher than people realize.)
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Ah beat me to it. The social worker probably just meant that if Travis was a woman, there may be a few more options available to him.
 
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BenBurch said:
In fact, that becomes a real problem in social work. You have sick people you are trying to get back into working as they are able, but they cannot take some jobs because they would end the essential medical coverage while not paying even remotely enough to pay for care out of pocket and not providing any insurance.

In addition, small businesses which have insurance for their workers are often unwilling to take on people who are ill as full-time employees because of what it would do to the rate in the small risk pool such a business represents.

So the system makes it hard for people to climb out of it by creating a huge uncovered gap the sick cannot make it across.

A true universal single-payer system covering 100% of all Americans would not have these problems, would help people remain in the workforce, and would increase the tax rolls.
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So we need to get rid of the system, right?

(yes, this is tongue-in-cheek poking fun of people who want to destroy all government)
 
Schrodinger's Cat said:
You speak the truth, good sir. I have seen people in the exact situation you describe. They genuinely want to work again, but if they start working, they lose Medicaid, and the new job either doesn't have insurance or doesn't pay enough to cover the out of pocket expenses. It's a really terrible position to be put in.

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I know whereof I speak because my wife works for a social services agency and even before I knew her I had worked as a volunteer trying to help people through a different agency.
 
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