Stanley Feld M.D.,FACP,MACE
We have all experienced absurd government regulations. The actual government policy might be praiseworthy. The execution of the policy hardly ever reflects the purpose of the policy.
The story of Moises and Medicaid illustrates an absurd execution of a policy designed to help the needy. The consequences are potentially grave to Moises and his family. The policy not only has health and economic consequences for the patients, but it has the potential for serious impact on everyone’s taxes.
The government has stated that we must provide healthcare insurance for all children as well as healthcare coverage for poor citizens. It says its goal is a morally just healthcare system.
I am telling this story not to incite anger but to underline the absurd and intimidating bureaucracy of the Medicaid system. Medicaid not only insures few people its physician reimbursement schedule is terrible. Medicaid has difficulty getting physicians to participate in the care of its insured.
In recent months there has been a lot of media frenzy concerning S-CHIP to insure poor children. President Bush has vetoed the bill twice because of his perceived defects in the program. Only students of the bill could understand the perceived defects because media coverage has been so poor. In our sound bite society the actual issues are constantly misrepresented. Everyone feels children ought to have healthcare insurance. Therefore everyone is against President Bush because it seems he is uninterested in the concept.
Policy makers debate the actual number of people uninsured. They argue that many patients are uninsured because they do not exercise their right to obtain Medicaid insurance.
It is true that many Hispanic US citizens do not apply for Medicaid. There are two important questions. How many do not apply? Why don’t they apply? One of the reasons is the Medicaid application is complicated. Most of these citizens are laborers with meager education. The impression given by the media is these citizens increase the number of uninsured through no fault of the government’s Medicaid program. The Hispanic citizens are at fault.
The actual names in this story have been changed. The story is a true story.
Moises is a 44 year old Hispanic male married with 2 children (4 and 6). He has been a U.S. citizen for 11 years. His is an honest and hard working citizen. He had Medicaid insurance coverage when his children were born. He tells me his coverage somehow disappeared. He could not find the reason why no matter how hard he tried.
His income in 2006 was $22,000. His income stream is unsteady. It is dependent on individual jobs and the weather.
I implored him to apply for Medicaid. If he or anyone in his family got sick he could not afford medical care. Some hospital day charges are more than his yearly income of $22,000. He would be liable for that retail price for hospital care with post tax dollars. Medicare pays between 35-45% of the hospital’s retail fees. Medicaid pays a lower percentage.
Moises was hesitant to apply for Medicaid. He was afraid he could not complete the long and complicated application. He was afraid he would get into trouble if he applied. This is an emotion many immigrants have. I volunteered to fill out the application for him. It was not an easy application to complete. I could understand the fear a foreign born person would have in filling out the application.
He completed the application and had it notarized on October 22, 2007. On November 3rd, 2007 he received a note from the Medicaid office in Austin. He was notified of a telephone interview scheduled for between 2 and 2.30 pm. December 3, 2007.
I could not understand why it took so long to have an interview. It was almost six weeks since the Medicaid office received the application.
The Medicaid office in Austin Texas was scheduled to call him on his cell phone on December 3, 2007 between 2-2.30 pm. He was afraid he might need help with some interview questions, he asked if I could be available to help him.
The Medicaid office did not call between 2pm and 2.30 pm. At 3 p.m. I told him to call the Medicaid office. The number given to call was 211. The telephone number was answered by what sounded like an outsourced answering service. The outsourced service connected him to somewhere at the Medicaid office. After several transfer connections and 30 minutes on hold he got some one live in the correct Medicaid office. They told him their computers were down. He did not understand what that meant. He handed me the phone. The Medicaid lady was not allowed to explain anything to me because I was not the applicant. After my long explanation she finally told me the computers were down. She said I should have Moises call back in an hour. He called back in one hour. It now took 20 minutes on hold to get someone that could help. This person tried to get on the computer system but failed.
She asked him to call back in the morning. He called back in the morning. This time he waited five hours on hold. When he finally got someone who could help, his cell phone ran out of power and disconnected. He decided to go to the local Medicaid office. He hoped they could help or at least tell him what he should do. Their advice was he needed to call back and reschedule his appointment.
When he told me of the advice I told him it was ridiculous. He waited six weeks for the appointment, and their computers were down. It should be their responsibility to speak to you before you have to wait another six weeks for a decision. Moises did not want to make trouble. He was hesitant to call again. He was resigned to wait for another appointment.
I convinced him that he would not get in trouble if he insisted on some one servicing his application now. He realized he must persist. He also got smart and brought his phone charger so he would not run down his cell phone battery. After three more days and six more hours of being on hold he finally got to someone who would look at his application.
She said they needed his income tax return and his children’s’ birth certificates. He had already sent them. The previously sent copies were discarded because they were not asked for on the application. He faxed his income tax return for 2006 and children’s certificates to the Medicaid office in Austin. The fax number was the only number he had to penetrate the Medicaid bureaucracy.
He waited another five days. The Medicaid office called him at a random time. The case officer said his children qualify for S-Chip. Neither he nor his wife qualifies for Medicaid. He asked why he and his wife did not qualify. The answer was that he makes too much money to qualify. She told him he can not make more than $800 a month to qualify for Medicaid in Texas.
Moises hung up without asking when he would receive official notification. He did not have a case number or a contact person. Two weeks have passed since he received the phone call and he has not received official notification.
It has been two months since the application was filed. He has no evidence of acceptance except someone’s word. He does not have a case number or contact person.
Imagine the frustration he is feeling.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Stanley Feld M.d.,FACP,MACE