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Old 11-02-2015, 03:01 PM
 
71 posts, read 160,636 times
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Hello, everyone! I am extremely confused about how Medicaid works.

I was told that if you are on a low income (very low) , you will be qualified, though not always. Then I was also told that even though Medicaid is free, there will be some deductibles. In other words, I was told by different people with different insights about the "true nature" of Medicaid.

I wonder if this has to do with the fact that every state has different policies, procedures and guidelines. That being said, shouldn't all the "Medicaids" be the same no matter which state you are in? Help, please!
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Old 11-02-2015, 03:06 PM
 
3,613 posts, read 4,090,106 times
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Quote:
Originally Posted by Jozeph View Post
Hello, everyone! I am extremely confused about how Medicaid works.

I was told that if you are on a low income (very low) , you will be qualified, though not always. Then I was also told that even though Medicaid is free, there will be some deductibles. In other words, I was told by different people with different insights about the "true nature" of Medicaid.

I wonder if this has to do with the fact that every state has different policies, procedures and guidelines. That being said, shouldn't all the "Medicaids" be the same no matter which state you are in? Help, please!
In most states, Medicaid is a sliding scale so the lowest income people probably won't have any costs associated with their plans but those that make a little more might have a $5 co-pay for an office visit or have to pay $2 for a prescription, etc., and yes, each state has their own guidelines.
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Old 11-02-2015, 03:36 PM
 
Location: Wisconsin
25,592 posts, read 56,255,266 times
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Quote:
Originally Posted by Jozeph View Post
I am extremely confused about how Medicaid works.

I was told that if you are on a low income (very low) , you will be qualified, though not always. Then I was also told that even though Medicaid is free, there will be some deductibles. In other words, I was told by different people with different insights about the "true nature" of Medicaid.

I wonder if this has to do with the fact that every state has different policies, procedures and guidelines. That being said, shouldn't all the "Medicaids" be the same no matter which state you are in? Help, please!
Medicaid programs are not the same throughout the country - individual states set guidelines for the programs in their states. Some states like Texas have such a low maximum income bar, that TX has an overpreponderance of poor without any medical coverage whatsoever. TX limits are laughable - due in large part in an effort to limit the drain on its resources because of its large indigent Hispanic immigrant population:

https://www.google.com/search?q=maxi...utf-8&oe=utf-8

Deductibles may or may not apply depending on your state requirements for what it may call a "spenddown." This is also income dependent per YOUR state guidelines.

You may believe all Medicaid programs should be the same in every state, but this is not the real world.

Keep in mind the ACA provided for Medicaid expansion in all states, with the govt covering 100% of the cost for a few years. Thereafter states would pick up 10% of the increased costs, the govt 90%.

The Supreme Court ruled Medicaid expansion under the ACA was not mandatory for the states. As a result, 22 states have refused this expansion, saying they can't depend on the govt to continue to pay the increased costs - and further consider Medicaid expansion another increase in govt-run welfare programs to which they are ideologically opposed.

Some GOP state governors are fighting budget battles and would now like to take the govt money - but their legislatures are opposing them.
Quote:
The ideological gridlock in so many state capitals is inflicting serious harm on state budgets.
http://www.nytimes.com/2015/03/16/op...ed-states.html
So, no, in the end Medicaid is a state-run program - and varies.

Last edited by Ariadne22; 11-02-2015 at 03:47 PM..
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Old 11-02-2015, 05:51 PM
 
Location: Austin
15,574 posts, read 10,286,574 times
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The problem with accepting the federal money Medicaid is that it is scheduled to decrease--leaving states holding the bag for adding more and more to it. Nice that no one bothers to report this.

Also, Texas will always pay a lot for those who do not have health insurance because we have significant numbers of illegal immigrants who will not qualify for Medicaid.

Finally, Medicaid actually expands ER utilization.

Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link
Arthur L. Kellermann, M.D., M.P.H., and Robin M. Weinick, Ph.D.
N Engl J Med 2012; 366:2141-2143June 7, 2012

https://www.google.com/url?sa=t&rct=...6oemdeOxMoKFsw

Another article on same subject:

http://www.hsph.harvard.edu/news/pre...y-room-visits/ January 2, 2014

"Adults who are covered by Medicaid use emergency rooms 40 percent more than those in similar circumstances who do not have health insurance, according to a unique new study that sheds empirical light on the inner workings of health care in the U.S.

The study takes advantage of Oregon’s recent use of a lottery to assign access to Medicaid, the government-backed health-care plan for low-income Americans, to certain uninsured adults. The research examines emergency room records for roughly 25,000 people over 18 months."

Last edited by texan2yankee; 11-02-2015 at 06:11 PM..
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Old 11-02-2015, 06:08 PM
 
Location: Wisconsin
25,592 posts, read 56,255,266 times
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Quote:
Originally Posted by texan2yankee View Post
The problem with accepting the federal money is that it is scheduled to decrease--leaving states holding the bag for adding more and more to it. Nice that no one bothers to report this.
Not true, evenyone has, including me, here:
Quote:
Originally Posted by Ariadne22 View Post
Keep in mind the ACA provided for Medicaid expansion in all states, with the govt covering 100% of the cost for a few years.

Thereafter states would pick up 10% of the increased costs, the govt 90%.
Further, and better analysis, here - which shows a modest net increase in costs:
Quote:
The Congressional Budget Office (CBO) estimates that the Medicaid expansion will add very little to what states would have spent on Medicaid without health reform, while providing health coverage to 17 million more low-income adults and children.

In addition, the Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some — and in a number of states, possibly all or more than all — of the modest increase in state Medicaid costs.

Expanding Medicaid is thus a very favorable financial deal for states.
  • CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022). The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.
  • The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.
  • This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured. The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019. The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.
[snip]
In short, the Medicaid expansion will cover 17 million low-income people at a very modest cost to states — a cost that will be at least partly offset by savings in uncompensated care and other state-funded services for the uninsured.

[snip]How Health Reform
Yes, there is more ER use because these are people who have never had insurance and have no idea how to use it. ER is their SOP - it will take quite a while to break that habit.
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Old 11-02-2015, 06:15 PM
 
Location: Austin
15,574 posts, read 10,286,574 times
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Quote:
Originally Posted by Ariadne22 View Post
[snip]ER is their SOP - it will take quite a while to break that habit.
Ask Oregon. Or Maine. Or Kaiser for that matter who detailed the phenomenon. Read the article I linked.

And by giving them an incentive to prolong or increase such "bad habits" (i.e. non-emergency visit to the ER) - they never will. Medicaid has been around for 5 decades now.

The other part of your post has been discussed ad nauseam.
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Old 11-02-2015, 06:28 PM
 
Location: Wisconsin
25,592 posts, read 56,255,266 times
Reputation: 23256
Well, then, why did you state I didn't talk about increased costs when I did - 100% v. 90%? You only amended your earlier post to specifically address ER after I had replied. ER use is a perverse consequence not foreseen and won't correct itself for quite a while. That doesn't mean Medicaid expansion is bad in its entirety. Growing pains.

There is no perfect program - and if each were never begun because of the fixes needed down the road - there'd be no point to doing anything. Suppose you also believe SS should never have been begun 83 years ago because now it needs a fix - as it has over the years? Yet, the program has been enormously beneficial and will continue to be with modest fixes.

Done talking. We are each beating a dead horse.
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Old 11-02-2015, 06:31 PM
 
Location: Austin
15,574 posts, read 10,286,574 times
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It does not matter to the hospital whether someone in ER is with a broken leg or a bee sting. Same $2,000 visit.

This is always very counterintuitive to those who supported ObamaCare on the misleading idea that it was about uncompensated, unreimbursed ER care which is a "whopping" ~2% of total HC costs.

Again, Medicaid spikes your ER utilization - not the other way around. A fact documented over the decades (Medicaid is a 50 year old program, so it is not nearly as poorly understood or not studied as the left asserts).

Final article, from NPR, a well known liberal site: Medicaid Expansion Boosted Emergency Room Visits In Oregon JANUARY 02, 2014
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Old 11-02-2015, 08:05 PM
 
Location: Chesapeake Bay
6,046 posts, read 4,790,103 times
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Quote:
Originally Posted by texan2yankee View Post
It does not matter to the hospital whether someone in ER is with a broken leg or a bee sting. Same $2,000 visit.

This is always very counterintuitive to those who supported ObamaCare on the misleading idea that it was about uncompensated, unreimbursed ER care which is a "whopping" ~2% of total HC costs.

Again, Medicaid spikes your ER utilization - not the other way around. A fact documented over the decades (Medicaid is a 50 year old program, so it is not nearly as poorly understood or not studied as the left asserts).

Final article, from NPR, a well known liberal site: Medicaid Expansion Boosted Emergency Room Visits In Oregon JANUARY 02, 2014
So who pays for that $2,000 visit?
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Old 11-03-2015, 09:50 AM
 
71 posts, read 160,636 times
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Hello, adriadne22, texan2yankee & Qwerty:

Thank you guys so very much for the detailed responses. I am sorry that because of me there were some heated arguments.

Kind Regards,

Joseph
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