Illinois State workers are busily processing new applications for Medicaid recipients that are piling on to the system under the new expansion due to the Affordable Care Act (aka: Obamacare). The Illinois Department of Healthcare and Family Services reports that this year 110,000 new individuals will be covered by Medicaid. Sounds great, huh? All those people getting health insurance coverage. But Medicaid isnt really like health insurance at all. First of all, the reimbursements to doctors and hospitals are so low that most providers cant cover the cost of doing the business, thus if a doctor only treats Medicaid patients, he/she goes broke quickly. Then there are limitations on how many prescriptions can be filled each month. Today, I was confronted with a dilemma. Medicaid pays for only 20 visits to a physical therapist per year. Period. Sometimes we have people who present with a musculoskeletal problem that might be treated with therapy, and if they fail therapy, then we might consider surgery. So I got a message that the therapist doesnt want to use up the available visits, if the patient is going to need therapy after surgery. This is a catch-22. It is likely that the patient will not need surgery if the therapy is successful, but they are afraid to use up their allowance this year, and then not be able to get therapy afterwards if surgery becomes necessary. Ahhhg! Medicare patients now also have limits on how much therapy they can have each year, based on $1900 per body part/injury, up to a cumulative total of $3700 of therapy per year. That may sound like a lot, but its not. There is a growing list of procedures that Medicare and Medicaid are no longer paying for as well. We are in serious trouble and I dont think it is going to get better soon. But there are a lot of people out there clamoring to extend Medicare/Medicaid to everyone. It is called Single-Payor.
Posted on: Thu, 30 Jan 2014 16:48:18 +0000