It’s often thought that the battle of Medicaid ends after being accepted – once admitted into the program, low income families should be able to receive the health care they need. Unfortunately, in certain areas of the U.S., families aren’t being accepted by the physicians in their zone, leading some ill patients to travel further distances, or to forego not receiving the preventive care they need.
Depending on where a Medicaid beneficiary lives, it can become extremely difficult to be accepted by a primary care physician. Even in areas where there is a large concentration of physicians, some doctors aren’t willing to accept Medicaid patients because Medicaid reimburses physicians at a lower rate than Medicare and private insurance. Access to preventive health care by Medicaid beneficiaries can be even more challenging in rural areas.
Attempting to find out how challenging it can be to obtain an appointment in a poor area of Mississippi, researchers posed as patients (half covered under Medicaid, half covered under private insurance) and called different practices. Researchers found that 47 percent of the new Medicaid patients were accepted by the doctors, whereas about 75 percent of new patients with private insurance were accepted. These margins alone exemplify the difficulty one can face as a Medicaid patient.
People who need Medicaid coverage tend to be sicker and to need the care of physicians most. Without being able to receive the care they need, most Medicaid beneficiaries members put off symptoms, and ignore the obvious signs. This can lead to worsening conditions. For example, patients with diabetes who don’t get treated can go into a diabetic coma, which requires emergency care and , if receiving the appropriate care, could have been is completely preventable with appropriate medical care.
SImilarly, in the Medicaid nursing home program, Medicaid reimburses facilities at a lower rate than Medicare and private insurance. Consequently, nursing homes limit the number of Medicaid patients they will admit, making it difficult for a patient to find a facility. Nursing homes often have waiting lists for the limited number of Medicaid beds in the facility. The process of finding a Medicaid facility and securing a Medicaid bed can be very stressful for the spouse or family of a patient who requires 24-hour nursing care and cannot be cared for safely at home.
The Stone Law Firm supports patients’ families by helping them find quality nursing homes and available Medicaid beds. We handle all aspects of Medicaid planning and applying for Medicaid coverage of long-term care, including in-home services.