Saturday, September 8, 2007

No Sense

Brooke is ready to leave the hospital – but she can’t. Brooke had a tracheotomy approximately six weeks ago, and her recovery has progressed very well. She’s now back to her happy, smiling self and is very anxious to get back to school and home. But, because of an insurance requirement, she is unable to do that.

Brooke, because she is adopted, has Medicaid insurance. Medicaid is usually a very good insurance, covering almost everything children like Ashley and Brooke (children with special needs) require. But sometimes the rules surrounding Medicaid insurance seem to get in the way – seem to do the opposite of what most insurance companies want to do – save money.

Brooke cannot leave the hospital until a nurse is found to stay with her during the school day and for a few hours after school. Even though the hospital would prefer that Brooke’s mom have 24 hour nursing care, Lynnette, like me, finds such a service intrusive and knows that she is more than capable of caring for Brooke for most of the time. Medicaid will only deal with three nursing agencies to find a nurse for Brooke, and those agencies have nursing shortages (more than likely because the Medicaid reimbursement rate is lower than the average nursing pay). So, Brooke, like many other children in hospitals who could go home if they found nursing care, stay in the hospital.

Even if a nurse could be found outside those three agencies, Medicaid will not cover the costs. Rather, by insisting on dealing with only the three agencies, Medicaid continues to pay high hospital costs – very high daily costs which could stretch into weeks and months because of the shortage of nurses at the three agencies. And families, like Lynnette and Brooke, end up suffering.

Lynnette’s job is secure for 12 weeks because of the Family Medical Leave Act. She does not get paid during those 12 weeks, but she is assured of keeping her job. After 12 weeks, all bets are off. So, Medicaid, in addition to incurring high daily hospital costs will very likely contribute to a parent losing his/her job and increasing the public assistance rolls.

Can someone tell me how any of this makes sense?

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