I am wondering what other free clinics that do not bill Medicaid do when adults with Medicaid with a deductable ask for care? I have had it come up a couple of times recently that people who can't afford the deductable - in one case it was $382 a month she had to pay before Medicaid would cover anything - call asking us to see them.
Thanks for your input,
Kathy Van Til
City on a Hill Health Clinic
Kathy, you are talking about Medicaid "Spend Down." This is a state program which is helpful only when the patient is hospitalized. So it is really catastrophic coverage.
At Cabrini Clinic we judge that someone with a Medicaid Spend Down is uninsured for primary care (which is what we provide), and so we do provide care for them.
There may be a problem when you apply for free medications for them from the indigent drug programs of the pharmaceutical companies. They may rejected because they have Medicaid.
Hope this is helpful. Mary Ellen
We have run into this problem for a long time. Mary-Ellen is right, it turns out to be good if the patient is hospitalized but pretty useless for anything else. To date, our Board still includes them under all Medicaid patients and we cannot see them. IF we did, I think it would be a real problem if they did not qualify for PAP medications. Really, it would probably be better for the patient if they didn't have this Spend Down at all. Because, if they are admitted, the hospital social workers will enroll them at that time.
It is good PR for DHS to say they are covering x number of people, but they shouldn't be counting this group.
We accept individuals with a Medicaid deductible in our program. My understanding is that the patient does NOT have to pay those out of pocket costs, per se. Rather, the deductible is the amount of medical care costs they must incur for MA to kick in and pay for it.
Melissa L. Hall
Medical Care Access Coalition
We are Loving Hands Clinic in Lapeer. We call these medicaid patients the"Underserved". If they have an unreasonable deductable amount, and can prove to you with financial documents (normally required anyway in order to obtain services from this clinic) that they need the services of a free Clinic...we allow them to be seen. On initial visit, we ask them to provide us with their medicaid benefits letter to show the amount of their deductable, food stamp letter, unemployment ltr...etc.
Kathy, it sounds like you are talking about medicaid spend-down. At our clinic we consider this to be under-insured , so we do care for these patients. some of them have deductibles as high as $1000. I always advise the pt not to drop the spend-down plan however as it will be wonderful if they have to be hospitalized.
We look at it the same as catastrophic insurance.
Let me know if you have more questions.