# "expanded medicaid"-  what's it like in your state?



## JaniceM (May 19, 2017)

I don't know how many other seniors here are still working full-time, but am wondering what the "expanded medicaid" system is like in other people's states.  
When the new system started a few years ago, I was notified that I was eligible due to my low income, although I wasn't eligible before.  
However, they have a category known as "medically exempt," and only individuals in that category benefit from this new system.  If you're not familiar with it, or if it's different where you live, it includes individuals who have serious medical conditions, severe developmental disabilities, mental disorders, or chronic substance use.  While the first two examples are logical, I don't believe the last two examples are.  

In contrast, although I have a lower income than people I know who are on SSDI, I'm only eligible for a few benefits through medicaid:  an annual "wellness" exam, dental exam, and eye exam-  none of which I bother with anyway-  but no dental work and no eyeglasses;  I'm eligible for ER treatment only if a condition is deemed a life-threatening emergency.  
It seems this state's new medicaid system is almost entirely set up to benefit individuals with mental health and drug/alcohol problems, and a person's income is irrelevant.
One of the dopiest examples:  months ago, I had an accident resulting in injured ribs;  while the pain was awful, and the swelling didn't ease up for more than a month, my concern was it's impossible to know the extent of this type of injury without an x-ray, but when I contacted the nearest health clinic they told me NOT to come in!  So I basically did nothing but "hope and pray" that it wasn't a break that could puncture an internal organ.  

So if anyone here is familiar with this-  what the heck's the point of giving people a medicaid plan when it doesn't include anything useful?  
Also, while I've only used the medicaid once (a couple of years ago for an ER visit), I receive bills every month-  expecting me to pay $5 per month to 'be on medicaid.'


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## HarryH (May 20, 2017)

I am not an authority, but you might consider making a list of Doctors, Clinics and Hospitals that accept Medicaid patients. Not all do and frankly... a lot don't. I suspect the clinic you referenced does not. Which would also require knowing which hospitals/clinics the doctor... which does accept Medicaid has privileges.

We have ran into the above with my wife's elderly parents. 

http://health.usnews.com/health-new...ouve-got-medicaid-why-cant-you-see-the-doctor



> “There are certain aspects of Medicaid, particularly for low-income populations, where it is really almost superior to private [insurance] coverage, with very low copays and no deductibles,” says Stephen Zuckerman, co-director and senior fellow with the Urban Institute’s Health Policy Center. “But at the same time, Medicaid beneficiaries are significantly more likely to report having difficulty finding a provider or delaying care because their health care coverage isn’t widely accepted.”



I should also mention, that Medicaid is not the only insurance with these issues. My oncologist has a private office nearby. When I transitioned to Medicare and then to an Medicare approved HMO, that insurance would no longer pay for services through his office. However, he also had a clinic within a hosptial, in a town 20 miles away, that did accept my new insurance... provided my primary physician gave a referral. The same basically with my Cardiologist. The office, where I live... NO. Her office 20 miles in the opposite direction... YES.

Long story short... having insurance does not mean it works everywhere.


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## JaniceM (May 20, 2017)

Hi HarryH, it's nice to meet you, and thanks for the reply.  
The problem, though, wasn't medicaid itself-  the clinic does accept it-  the reason they told me to not come in was they said it's not an 'urgent care' clinic.  They advised me to go to one, but from the
address they gave it was around 15 miles away.  It wasn't "doable" because I didn't have transportation.  
What really steamed me:  later I found there's another urgent care clinic not far from the clinic I contacted, and it was on the bus route-  but they didn't tell me about it, probably because it's connected
to a different hospital.  
It's beyond me what a regular health/medical clinic does, if they can't even do a basic exam and x-ray.


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## terry123 (May 22, 2017)

I don't have Medicaid, don't qualify. But I do know if you have a HMO you have to go to what docs are on your plan and have to have a referral to go to a specialist.  I have Humana PPO which means I have a network of providers I can see.  I made sure all of my docs were in the network before I signed up.  Also you don't have to have a referral to see a specialist.


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