As someone with a disabled mother on medicaid (whom I spend tens of thousands of dollars a year on for prescriptions and care), thank you.

Can I ask why you're spending thousands of dollars on Rx and care? From what I've gathered Medicaid patients have co-pays of $3-$5 on drugs and very small office visit co-pays.

I'm not questioning your story, just genuinely curious what the extra costs are.

Not a problem

My mother is covered by Indiana's medicaid program, as she's at the poverty level but not old enough yet to qualify for Medicare. Her prescription buydown/deductible every month is $550, which I pay for. If you don't mind, I don't want to list specific medications, as it might make it easier to determine her identity. She takes medication for bone mineralization, hormone replacement due to a heart condition, a medication to reduce her blood pressure, as well as a Schedule I pain killer 3-4 times a day for pain management due to lower body nerve damage. She'll very likely have some nerves in her lower back severed in the next 6-12 months to relieve the pain.

So, her prescriptions alone cost around $5K-$6K/year. This is before her GP or specialist copays (very few providers will take Medicaid patients, so its hard to find and keep them), or a hospital visit or two. Her recent open MRI was completely out of pocket (luckily only $600 at a low-income clinic).

Thanks for sharing. I wasn't aware of Medicaid patients who had to pay those types of costs.

I guess my question is, what if a Medicaid patient in IN was truly destitute? There must be some mechanism for patients who can't afford those types of costs.

ER visits.

Seriously. An ER is required by law to treat anyone who comes in. If you really can't pay, go to the ER.

Some argue this is why healthcare costs so much because ERs have to be paid for.

No. This is wrong, yet people keep citing this.

EMTALA [0] requires the hospital to stabilize the patient, ie, make it so that it is no longer an emergency (the "E" in "ER"). If you "really can't pay" and it's not an emergency, you likely will find yourself in collections from the hospital.

[0] http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and...

I think it really depends on the hospital. Some hospitals that are in major urban centers and provide services for a large indigent population often waive all expenses.

If you go into one of these hospitals looking like you have no money, you'll likely not be asked to pay anything.

So if you go and say you are seizing, they will just stabilize you till you are done seizing then kick you out? Or at that point they will attempt to collect for the emergency care and prohibit further care until you can prove you can pay for it?

Generally yes. This comes up occasionally with cancer patients; if they have an acute issue the hospital must stabilize them, but the hospital doesn't have to actually treat their cancer.

If they are very poor, they should in theory be covered by Medicaid, which will then pay for treatment. But this requires them to actually be in a condition (mentally/physically/education-wise) to figure out how to sign up and be approved for it, since coverage isn't automatic. Afaik, even if the hospital is able to determine the person should be eligible, they can't just treat the person and then sign them up on their behalf; the person has to do it themselves, and be approved before seeking treatment.

This is one area that I think the U.S. lags behind many other developed countries in: assigning a social worker to help people in bad situations navigate the system. I've noticed that with an uncle of mine who has MS, is on SSI disability, and can't really take care of himself. If he didn't have a family member who was willing to accept power of attorney and file all sorts of paperwork and make phone calls on his behalf, he would have huge problems, because he isn't able to do that himself, and the state has not assigned a social worker to help him out.

>But this requires them to actually be in a condition (mentally/physically/education-wise) to figure out how to sign up and be approved for it, since coverage isn't automatic.

This is a tough one. I have a disabled family member who would have never been able to do this themselves.

People often claim that, but it's not a particularly credible argument. Emergency room visits account for less than 2% of total healthcare spending in the US.

http://newsroom.acep.org/index.php?s=20301&item=29928

Moreover -- ER visits with fake names. I have no moral issues, completely nothing, 0, lying and stealing from the bastards that sell $300 for a bag of saline or $40 for a pill of aspirin. I don't care that nobody pays it, I don't care what complicated laws or accounting tricks are, if that is put on a bill and sent to a person who was just sick or injured, that is wrong. It is criminal. So if you are conscious and can get way with it (don't need prescription written out just want to get "stabilized"), give them a fake SSN, name, address and fuck them.

Um this is the reason for Obamacare. People sticking other people with the bill.

People will gladly pay $500+ for an iphone but will not spend money on their own health. Yet they expect the hospital to be forced to take them even if the they can pay.

Are some hospital charges a ripoff. Oh yes. But they are also open 24 hours a day with highly trained staff ready to try and save your life even if you were doing something dumb. They are on stand by even though you pay them nothing to be waiting.

Fire fighters. Police. Both do the same job, both paid for by property taxes. Why is a hospital not the same?

> An ER is required by law to treat anyone who comes in.

They're basically allowed to make you "stable" and then send you out into the cold. They might do more but they don't have to.

unfortunately, i think its usually death.

Ok, I think I understand now. I'm guessing your Mom is slightly above the poverty line?

* For people with incomes above 150% FPL, copayments for non-preferred drugs may be as high as 20 percent of the cost of the drug. For people with income at or below 150% FPL, copayments are limited to nominal amounts.[1] *

[1]http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By...

They include her husband's income, which is only social security and an extremely small pension that barely covers their food, utilities, mortgage, and property taxes. They don't, of course, take into account his medical expenses in the income calculation.

Have you looked at programs offered through the manufacturer of her medications? Many have programs for free or low cost meds for low income people who are un or under insured.

Try here

http://www.pparx.org/en/prescription_assistance_programs/lis...

IIRC, Medicaid has some odd situations where they'll pay for nursing homes but not 10x cheaper (and better outcome, in many cases) home-health aides.