A friend of a friend works with Medicaid and provided this insight into WHAT IS MEDICAID, WHO needs it, HOW it works. This is really educational, and even if you have insurance and you become disabled, you'll need medicaid. READ ON!
INSIGHT ON MEDICAID
Clearly people in Facebook land are confused by Medicaid.The libertarian mantra that everyone should pay their way pops up like whack a mole with every single protest or article about why people with disabilities fear for their lives and well being if there are cuts to Medicaid. “We need to cut spending, and what about those cheaters and people who refuse to work!” says your republican uncle. “I work hard for my insurance” says your clueless coworker.
Medicaid policy is really complicated. I’ve spent years studying it, so I can change it and continue to reform it. It definitely needs work. But I will repeat my mantra again and again. Elimination is not reform. Public systems are big ships to turn. Refusing to fuel the ship does nothing but leave millions of passengers at sea. So here are some helpful facts to have in your pocket for future conversations. Keep educating the beast and we will win. Screaming at the beast just makes it stronger.
Medicaid is not Medicare. They are separate programs. Please google this if you don’t understand the difference. Everyone should take a minute to at least understand the basics of these two programs.
WHAT IS MEDICARE THEN? Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income.
Medicaid serves different groups of people in very different ways. It is not one thing. Some Medicaid programs are primary/acute care for people in poverty, and some are not.
Primary and acute care is what those of us who have health insurance, use it for. We see the doctor, have babies, surgery, rehabilitative services and so on. We even have accidents and illnesses that cost an unbelievable amount of money to treat. That’s really hard on the under or uninsured. When our children are born with disabilities, or when our accidents or illnesses become permanent disabilities we require more than Primary Care. We now require chronic or LONG TERM CARE. This may include things like walkers, wheelchairs, on-going therapies, Personal care assistants, medical transportation for those unable to drive and so on. Long Term Care is provided through a type of Medicaid that one becomes eligible after a rigorous disability determination.
Here is where people get confused. Even if you have Cadillac insurance, it is primary care insurance. The insurance industry inserts all sorts of clever language to limit how much Long Term Care coverage they provide. Some provide a little bit like basic wheel chairs. But most draw the line at many items (aka billing codes) that can be described as Long Term Care. The insurance industry gamed the system long ago. They will not pay a dime for what Medicaid will cover. So, if you become disabled, your insurance will only go so far. You will be entering the world of Long Term Care. Your assets will be drained until you are Medicaid eligible. I can’t tell you how many times I have heard people…usually libertarian leaning ones say, “I work hard and pay for my insurance, so I will be covered if something happens to me!” No, you will not. You will be seeking Medicaid for your Long Term Care Needs. Even if you have a whole lot of money, it will be gone faster than you can imagine. There is no “pay your way” unless you are in the 1%.
When people have a disability and seek Medicaid eligibility for Long Term Care, they go through an extremely rigorous screening process for a disability determination. Even children go through a multi layered determination process. I know this because I used to administer part of it. We screened out many children who needed more support than even the best HMO would provide them. This is fact. Getting a disability determination happens in a few different ways and is administered differently based on age, type of disability and so on. That’s a whole other discussion. Just be clear…it’s not simple or flexible about who it includes.
Medicaid at its best has been woefully underfunded and bureaucratic. Advocates have worked long and hard to expand Home and Community Based Services. Medicaid used to only pay for institutional settings that were hotbeds of human rights violations. Imagine if you were only able to get assistance with your daily living skills by living in a poorly funded hospital like setting and you weren’t allowed to leave? Ironically, research has shown institutionalization with all of the hellish outcomes, costs tax payers a whole lot more in the long run. There are profits for the CEOs of private nursing homes and care facilities though. It’s easier to expand the disability industrial complex and for profit privatization of care when institutionalization is the default.
So, when people with disabilities claim their lives are threatened by radical cuts to Medicaid cloaked in block grants and delayed percentage increase and muckity muck language…..they mean it.
-Provides babies born prematurely or with congenital health issues home oxygen and nursing to save their lives. (Why so called “pro-life” republicans cutting Medicaid is the craziest thing in politics.)
-allows people to live independently with personalized support in the community rather than being institutionalized.
-guarantees people to get the mental health support they need.
-pays for bath chairs, orthotics, certain medications, speech generating devices and so on.
-allows people to be tax payers by supporting them at work.
-pays for critical early intervention services for children.
Research has shown better outcomes for community based living across all categories. It’s not controversial or up for debate. We did that already.*This is my overview for educational purposes. It’s not comprehensive to all of Medicaid or specific to the many nuances of exact Medicaid policies that vary state by state. Naomi S.