It's not HMO anymore, but MCMS (Medical Cost Management System)

By CHARLES C. RYAN

Think dealing with Medicare is difficult? Try Medicaid.

When my mother was admitted to Mediplex, the social worker said that she only had a few days of Medicare eligibility left for nursing home care and we should either make arrangements to pay privately, or apply for Medicaid.

I told her I had already begun filling out the application for Medicaid.

Medicaid wants to know everything. And it wants the patient to be absolutely busted. Broke. Penniless. Totally helpless and at the complete mercy of its wonderfulness.

When you apply for Medicaid, you aren't treated like someone who has turned to the government for help after exhausting all of your own resources. You're treated like a criminal and a cheat who is out to push up the tax rate and bankrupt the system.

Forget any form of self respect, dignity, or humanity, all ye who enter here.

I filed the first application in August 1998. It was immediately rejected and I was told a few million more details had to be provided. You have a month to get the information or your case will be dismissed and you'll have to start all over again.

It took about eight weeks to gather the data the agency had requested.

The second form was sent in October.

It was rejected again. Ma had too much money. She had insurance policies which had cash values more than the agency could accept.

A second level of bureaucracy was dealt with at the insurance companies as loans were taken out against the cash values and the loans were used to pay down the house mortgage. We aren't talking about huge sums here, more like $4,000-$5,000.

The mortgage was incurred for medical costs, so that was acceptable.

This took more time. Finally, In January, Ma was accepted.

Except ...

Of the $1,408 she received from Social Security, she could use $405.14 of it to pay her Blue Cross/Blue Shield and AARP health insurance policies. She could use $60 a month for personal items.

The rest must be paid to the nursing home.

What about the $500 a month due for her mortgage? What about the $1,703 a year in real estate taxes? The $370 for water and sewer fees? What about house insurance, electricity, gas, telephone?

Tough luck.

Medicaid allows you to seek payment for some medical bills for up to three months prior to the date the patient applied for Medicaid.

Except if you paid those bills, rather than leaving them to pile up, you are out of luck.

So all of the money which was borrowed against the house to pay medical bills doesn't count.

"We don't care about that," was the response.

Oh, yes. A lien was put against the house to recover any costs Medicaid incurs.

Er ...folks, how can there be a house for the lien to be placed upon if the bank forecloses for non-payment or the city forecloses for failure to pay real estate, water and sewer taxes?

How can there be a home to take Marguerite home to for the Personal Care Attendant program if she can't pay mortgage, taxes, insurance, and utilities?

I asked my sister, Mary, to call Lahey Clinic so it could perform a psychiatric evaluation on Medicaid, but she thought I was joking.

The problem is that we do not have a health care system in this country. What we have is a Medical Cost Management System.

You'll notice the words health and care do not appear in that description.

Those words do not appear because health and caring are not part of the system now.

Yes, there are many doctors and nurses and aides and hospitals and nursing homes that actually do care about health and caring for their patients. In fact, the United States has the best doctors, hospitals, and medical research facilities in the world.

But the insurance plans, the insurance companies, the government, won't let anyone use them.

The insurance providers and Medicare and Medicaid won't approve payment for the procedures or treatments the health care professionals believe the patients need. They won't pay for the staffing levels at hospitals and nursing homes necessary for adequate care.

I have a letter on file from Andrew G. Villanueva, M.D., of Lahey Clinic which states clearly that my mother needs 24-hour-a-day care.

He didn't write the letter because we are friends. He didn't write the letter because he was bribed or threatened. He wrote it because as a health care professional he knows what level of care she needs.

But there isn't anyone in the health care industry who cares enough to even read that letter.

-- C.C.R.