(the below is based on my understanding of how this all works)
Medicare is a federal thing, granted to people over 65 (or 67?) and to the disabled (and some others). To receive Medicare as a person with a disability (PWD), one must be declared “disabled” by the Social Security Administration (SSA). The SSA determines the declaration on the person’s ability to obtain and maintain “gainful employment”. SSA is completely employment based. PWDs who gain the declaration from SSA receive Social Security Disability Income (SSDI). The amount paid is based on how much the person paid into the program while working. If a person was self-employed and did not pay into the program, they are not eligible for SSDI nor Medicare.
Medicaid is a state thing. Most states base the eligibility on income although there are other criteria.
A person can have one and not the other or they can have both. I have both. I have Medicare because I applied for and was granted SSDI about ten years ago. Since I cannot be on Lorna’s insurance even if we were married (DOMA), I have both medical and prescription coverage under Medicare. I have Medicaid since they only consider my income and, including royalties and SSDI, I only earn about 11K a year. Because Lorna and I are not married, she is seen as a housemate. Even though we support each other financially, her income is not taken into account.
Like most states, North Carolina is losing money. And like most state governments the first place they discuss cutting is Medicaid. NC has a new Republican governor, Pat McCrory who from the beginning is proving to have his head up his ass, one hand on the Bible, and the other hand doing a circle jerk with the other Republicans and the corporations who own them. One of his first moves was to threaten closing several liberal art state college programs, primarily any gender studies. Even though hundreds if not thousands of businesses (including rape crisis and victim advocates) use these educational programs, McCrory believes they are wasting tax money.
Now McCrory wants to “privatize” Medicaid. His idea is to have 3-4 groups hand out the money in the form of physicians having only X amount of dollars to spend on each Medicaid patient.
Let that sink in a minute.
Several years ago, Medicaid tried to limit how many physical therapy visits a patient could have. I can’t remember the amount but it was ridiculously low. So low that many patients with chronic conditions would have run out of their yearly allotment in less than 6 months. I was one of those people. I could probably go to PT twice a week and have something legitimate to work on. We had to teach me the steps, have me do it at home, then come back in two weeks to discuss and learn the next. It was tricky because I had to make sure I was doing it right, had to make up materials and equipment, etc etc etc. It was a pain in the ass for me and the PTist. She actually used me as a case study to present to the state board as she and other PTist began their “Are you fucking nuts?!” discussions. Other problems were because I didn’t fit into any single box in terms of medical definitions. I didn’t have paraplegia so I wasn’t eligible for certain things even though I needed it. I didn’t have MS so I wasn’t eligible for other things. We did a lot of headbanging for about two years until it was “fixed”.
And what McCrory wants to do is worse. This would limit not just my PT, but everything from blood work to equipment to tests to surgery. What happens if my doc runs out of my funds and I get ill? Or what if I am healthy and don’t use my allotment? Do I then have less the next year?
Hey, McCrory, you want to save the state money? How about taking a pay cut like everyone else has? No? How about looking at the money the state pays each year for those idiots to build their big houses on sand and expect the state to rescue their asses year after year when hurricanes come? No? Still stuck on chasing pennies while hundreds blow in the wind? Okay, then take a look at how much the state is paying for medical equipment. The 24v gel cell deep cycle batteries for my chair cost the state $500 each. My chair uses 2 of them. The state “rents” my CPAP for 13 months then buys it for me. In that 13 months, you could have bought me about 3 machines of much better quality than the dumb doorstop I got. You won’t pay for my $50 a year dental check up but you will pay the $14K dentures I will soon need. Shall I go on?
Better yet, allow Lorna and I to marry so I am no longer eligible for Medicaid! Wouldn’t that be so simple? Wouldn’t that save the state a ton of money since I’m sure we’re not the only lesbian/gay couple with this situation?
[/rant] (for now)