Medicaid is a program for individuals who can't afford to pay for medical care. You may be covered by Medicaid if you have high medical bills; you receive Supplemental Security Income (SSI); or you meet certain income, resource, age, or disability requirements.
This is the official idea behind Medicaid. It was designed to help take care of medical costs that you can't manage on your own due to one or some of the reasons above.
Medicaid differs a little from state to state. It's foundation is the same, however, it depends on the state's terms, conditions and budget.
The following is a description of Medicaid coverage in one particular state:
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.
smoking cessation agents
treatment and preventive health and dental care (doctors and dentists)
hospital inpatient and outpatient services
laboratory and X-ray services
care in a nursing home
care through home health agencies and personal care
treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
family planning services
early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
clinic services
transportation to medical appointments, including public transportation and car mileage
emergency ambulance transportation to a hospital
prenatal care
some insurance and Medicare premiums
other health services
If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.
For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).
The information above is a sample of what types of services a person can expect from Medicaid, and in many cases these services help provide what Medicare does not, so that the cost of medical care is not overwhelming for a senior or other individual.
If you think you qualify for Medicaid, contact your state's Medicaid office to begin the process of finding out. Even with budget cuts, Medicaid can help defer medical costs not paid by Medicare.
There is a lot of controversy these days about what should go and what should stay in the huge U.S. budget which affects each state's and county's budget. Somewhere in that mirage of confusion, site Medicaid.
Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.
Seniors and individuals with very low income often depend on Medicaid to get basic medical care. Nothing fancy or frilly. A few doctor's visits, maybe some tests and some medication. Medicaid is what is supposed to help these individuals who can't afford Medicare Supplements and who need to have regular medical care - even minimal care - to stay reasonably healthy.
When hearing what people on Medicaid have to say, they say it is a lifesaver - literally - in many cases. They say that without it they would be in a hospital somewhere very sick or dying at the state's expense. The unfortunate situation is that as budgets get leaner, criteria for people to qualify for programs gets tighter and more people who need this help are left out.
The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.
There is a lady who is 59 years old and lives with her children. Her only income is assistance since she is too young for Medicare and she has a disability that will probably continue the rest of her life. She has applied for Medicaid which she said was an escapade of jumping through hoops, and after she turned in every single paper (about 1/2 inch worth) she was denied. The woman can hardly walk. Her blood pressure is out of control, she has been in and out of the emergency room because her blood pressure has been so high they are worried about her having a stroke, and instead of accepting her to Medicaid to get the care she needs, she was turned away. So at age 59 she goes to sleep, fearful that she won't wake up, and there's nothing she can do unless things get so bad she goes back to the emergency room.
There are seniors that are worse off, who choose between groceries and medicine and use less of both, keeping them hungry, undernourished and undermedicated, while their condition gets worse.
In these times, it is understandable for cutbacks to happen. It is simply a matter that some of them don't make sense. In the richest country in the world we are letting seniors and others starve and suffer just to save a few dollars - and then it cost thousands more to care for the individuals anyway.
It is important for everyone to have a chance to feel as good as possible and get good care. Hopefully as budget cuts continue, the president and lawmakers will remember that there are people living on much less than $250,000 or even $25,000 per year through no fault of their own. It is important to think about their dignity and well being when putting programs on the chopping block.
I saw this article while reading The Seattle Times. I read papers around the nation regularly to see what people have to say about the healthcare situation we are in as a nation. There are as many millions of opinions as there are people and lawmakers are playing tug of war with the situation. The problem with that -at least the biggest problem - is that they have the best healthcare in the world.
If they get a hang nail, a hernia or a heart attack their healthcare will cover it. The rest of us who are not covered like that or not covered at all can be having a stroke going into the hospital and being questioned as to whether we have insurance or not while we can't hold our head up in a wheelchair. This happened to my friend just before she fell out of the wheelchair, had an aneurysm, went into a coma and died a month later. She was 42 years old.
Here is the story from The Seattle Times:
Then there are the common people like us. Some of us have no healthcare because we make just a couple of dollars too much for Medicaid. OK. If that is so, than let us pay the two
Richard H. Cooper wrote in The Seattle Times about the need to fix Medicare before letting government undertake another program.
I agree with all his points about improvements needed to this program. However, I believe there is a way to fix it and do health-care reform at the same time.
There's already House Bill 676, the new-and-improved Medicare Act. This bill will put everybody in Medicare, and as we know, the bigger the pool, the less the cost.
By having only one nonprofit financing mechanism for our health care, we can save huge amounts of money. Imagine all the premiums now going to for-profit insurance companies whose goal is to make as much money as possible, not make our population healthier.
Also by having one financing mechanism, we can save huge amounts of money for practitioner's by reducing administration and overhead costs.
Secure public coverage for all will also mean a lot of people will retire that now just work for health benefits, and some will start businesses and provide more jobs because the burden of health-care coverage is lessened.
We already have a mechanism for employers and employees to pay a Medicare tax, so it can easily be adjusted to cover all and substitute for paying premiums. And with a tax, one pays according to income as opposed to with a premium. It's a fair and simple way of reforming our health-care system.
But most important of all, this system gives us the most bang for the buck, and I do not want my tax dollars to subsidize for-profit health care.
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
This is a question that keeps going back and forth between all of the individuals who are working hard to come to a solution to the healthcare and Medicare woes. Each side of the issue feels strongly about their position.
One side says that Medicare needs to be done away with or completely changed. They feel it has too many flaws and issues, as well as financial deficits, so that we might as wel start from the beginning and build something new.
The other side feels that the foundation of Medicare is perfectly fine and started out differently than it is being used now. Still, the foundation could still be used now with a few changes to make it work better.
From a lot of articles I have read, though there are flaws in Medicare and the need to be adjusted, as most or at least half of the the individuals involved in the debate agree, the foundation is solid, and after all, it has worked for several decades.
Part of the issue, of course, is that the beginning, there were a lot fewer Medicare recipients at that time. In addition, the costs of medical care were far lower than they are today. So lawmakers have been working on both ends of the issues - trying to get healthcare costs under control while at the same time, trying to make sure that Medicare recipients get their needs met to the extent possible.
This can be a model for healthcare reform from the standpoint because if the foundation for Medicare is used to build upon to reform healthcare, it could eliminate some or most of the flaws as well as making medical care available for all.
Time will tell how all the situation works out for both Medicare and Helthcare reform. Hopefully the reforms will result in at least basic medical care for all, which is something that is sorely needed in this country.
It's no secret that Medicare has problems to be fixed. However, the issue regarding oxygen support for patients on Medicar who need that type of treatment to basically stay alive is confusing Medicare recipients. The gist of the proposal by President Obama and his team working on Medicare and Healthcare reform is that first of all, patients will continue receiving their oxygen.
This is an important point, since the way it sounds as lawmakers are hashing ths out is that patients coule lose their oxygen care. This should not happen. It is an issue to be hashed out with oxygen providers and not patients. What is actually proposed is that from the time that individuals on Medicare begin oxygen, suppliers and providers will provide it at their regular prices for the first three yeas that it is being provided.
Once the three years are up, the providers will continue providing oxygen services at a lower price for two years and then they will go back up to their regular price, or if there is enough money by then, they may receive a slightly higer price because they hung in there and kept providing services at the lower price for those two years. This is the part where it gets sticky because, as you can imagine, suppliers and providers aren't too happy about getting a dock in pay.
As part of the Medicare reform, the President and lawmakers are trying to figure out this part of the deal for oxygen suppliers. They are trying to make it affordable for suppiers and providers to be able to continue suppling oxygen to their customers.
After those two years at a decreased amount in pay to the providers and suppliers, the price, as we mentioned above, will go back up to the prevailing price or possibly a little higher, as a sort of bonus for the sacrifice made during those two years. The important thing about all of this is that Medicar recipients who rely on oxygen services will continue receiving them.
Most oxygen service companies do not just serve Medicare recipients meaning that they have income from other sources, plus they get to know their Medicare clients over the years, so most of them will continue to help them because we are all human trying to help one another. The President and lawmakers are trying to take the money they have for Medicare services and, instead of making huge cuts in one area, they are trying to make smaller cuts in several areas so that providers including oxygen suppliers, home health care, doctors, nurses, technicians, hospitals and more, can continue to provide services.
They are trying to find a way to make it affordable to the healthcare providers without taking those services away from Medicare recipients that depend on them. As for oxygen services, if you are on Medicare and receive oxygen services, they will remain uninterrupted. Three years down the road, you may have to switch providers if your provider is not willing to take a cut in pay, however, you will still have services - just from another company.
Also, since the President and lawmakers are still working on this, it may actually turn out better than some people think. After all, if I provide you services at a good price for three years, then take a cut in pay for two years knowing that after that, I will be providing for you at a higher price after those two years and there will be no more cuts, I am not going anyplace because I have a loyal, long term client that I may be serving for 10 or 20 years. When I look at it that way, what's two years at a lower pay? So, those of you on Medicare using oxygen services, don't start worrying.
The government is trying to figure out a fair way to keep your services going. You will not have to give up your oxygen. Your provider may have to be willing to be more flexible during those two years if possible, or you will get a new provider. So try not to worry and just breathe a little easier.
Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients.
I have talked to doctors and other healthcare professionals who treat Medicare patients. Some of these have a patient load of 50% Medicare patients. I know of a few that treat nearly all Medicare patients because they have no place else to go. The majority of doctors say they can't afford to take on any new Medicare patients. The sad part of the situation is that with the right "tweaks" many doctors could take a few Medicare patients each. If a doctor is taking home $250,000 per year and took 10% Medicare patients, it wouldn't make him or her go broke, it would bring in extra money and it would help elderly people who need medical care. If he Medicare system could help devise a way where doctors got something out of treating Medicare patients and send out information about this to every doctor in the country, more doctors would be able to take a few Medicare patients and more elderly would be receiving continuous treatment. This would save money for the system because even if these doctors who took 10% of their caseload as Medicare patients and received a small bonus or other perk for doing so, the majority of patients would stay healthier longer and avoid costly trips to the emergency room or costly stays in the hospital or long term care. Medicare pays for these. If a doctor could help Medicare patients stay healthier and out of the hospital, perhaps he/she could receive a bonus which could come from a small percentage of what was saved for Medicare by keeping the patient healthy and at home. So the doctor gets $1,000 and Medicare saves $10,000 to $50,000. That sounds like smart finance and a win-win situation for everyone.
The elderly depend on Medicare. Some still have the means for private insurance, but even so, their Medcare benefits help defray other costs. There are ways to make sure that doctors can afford to treat Medicare patients and make enough money for it to work while at the same time actually saving Medicare money.
I am not privvy to the information being discussed in the battle over Medicare, Social Security and Healthcare by lawmakers on the hill in D.C. I just know that if I can think up something this basic, the leaders who are far more savvy than I am should be able to come up with a solution to keeping our elderly covered by Medicare and our doctors willing to take Medicare patients. There is enough time for these intelligent thinkers to come up with a plan that will work for everyone. This is not a maybe. This is a moral imperative.
It's no secret that Medicare has some problems and flaws, and it's no secret that some pundits and lawmakers would like to just toss it in the trash and start over - or not. The unfortunate part about eliminating Medicare is the millions of seniors it would affect - seniors who depend upon Medicare to survive - literlly.
Many seniors live on Social Security and bring in well under $1,000 per month to pay all their bills including their rent. They can barely afford to keep the lights on and food on their table, and the only way for them to get medical care is through Medicare.
Even with its flaws, Medicare helps millions of the most vulnerable among us. What would you do if you had diabetes, were 70 years old and had no place to go for treatment and no way to get medication that basically would keep you alive? What about if this was your parent and you didn't have the money to help because you lost your job, your savings and your retirement in the recent downturn in the economy? That's a pretty difficult question to ponder because in many situations we are talking about life and death.
Then there is the next group in their 40's or 50's where Medicare will be critical to them soon - especially if they already have high blood pressure, diabetes, heart problems or other serious issues. What will they do if lawmakers eliminate Medicare? What if they don't have the money to get care for their medical conditions. I have a mother who helped people get assistance for many years and it was gruesome. It isn't getting more fun as the financial and other problems have gotten worse.
I have read many theories on what to do with Medicare. The most of them made good points on cutting out fraud and waste and changing the system so that those that do certain things to both treat their patients well and keep costs down (it is possible) receive bonuses, while those who don't measure up not only don't receive bonuses but get deductions in pay. If they really don't measure up, they can be investigated and possibly eliminated from being able to be a provider in the Medicare system.
As for fraud and waste, these issues have been handled internally like the fox guarding the hen house, for many years. It is time for an outide independent entity to keep track of checks and balances and make sure they are real. If a medical supply company or doctor's office or hospital orders a certain amount of a particular product or suppy, there should be an outside middleman making sure that what's ordered is received and is paid for to the penny. Just eliminating this kind of fraud will save Medicare according to the CMS at least one billion dollars per year. Think of how many services that would provide.
There wil be no easy fixes, but there are fixes and if the best and brightest lawmakers unite, regardless of party or who likes who, Medicare can not only be fixed - and this may take some time and a lot of work - but the foundation is good, the model is right and Medicare can be fixed before the money runs out, leaving enough for our children and grandchildren rather than leaving them nothing.
