There were both positive and negative experiences with receiving Medicaid while pregnant and with a newborn. I think the best way to go through them would be in categories.
The Application Process
Because we knew the insurance change would be coming, and that I was pregnant, and that we were now required by law to have insurance, we started the process before my insurance was dropped.
Both R and I are educated people, with post-graduate degrees. We are used to paperwork, forms, formal processes, and red tape. We filled out all the paperwork online as requested (R initiated it). We received a notice back that proof of income was needed, and how we could submit it. Before we submitted the required paperwork, we received another packet in the mail that looked like we had been approved. We were both skeptical of this. We hadn't completed our application as requested, and yet we were being sent another packet with additional instructions to complete - which included creating online profiles. We were also skeptical of this. There was nothing that stated that we had for sure been approved, just a seemingly random packet of information. We put the information in a file and, in all honesty, forgot about it for a month or so. There was a lot happening and it was one thing that didn't make a lot of sense to us, nor was of highest urgency, yet, and so it sat.
As time went on, we revisited the process, this time I initiated it, and we received the same notification that proof of income was needed and where to take it. I also needed to submit proof of pregnancy, and so I called my OB office and asked them to fax the proof to the Assistance Office. At the time, there was something that I needed to take in person to the office (or thought I needed to take in person) and so we headed out. And so began our experience at the assistance office. It was our one and only experience, but boy was it eye opening.
The Assistance Office
In the course of 4 months I was in the Assistance office once, the DMV once, and the Social Security office twice. I'd have gladly taken 3 more trips to the DMV and 3 more trips to the SS office before I ever went back to the Assistance office. In fact, I opted to deal with the hassle of having to return calls the benefits office after each appointment to verify that yes, my last name had changed, no I had not changed it at the assistance office yet, so that the visit could be processed. (After the 2nd time, I wised up and started telling the check-in receptionist at each appointment about the last name difference and didn't have to deal with the calls anymore.) Anyway...the Assistance Office.
An initial check in point where you tell them why you are there. They give you about zero information, a number, and direct you to a tiny waiting area with more people than chairs. Chairs that are miserably uncomfortable. People come and go with varying degrees of urgency (from their perspective) and the person responds exactly the same to them all. It's freezing in the room. It's also dirty. The walls are scratched. There are giant signs, that have been written on, that state no food or drink. There is no bathroom in the room, only out in the main lobby of the building and if you miss your number being called, you go to the bottom of the list. There is a long row of windows with about 1/4 of them occupied by someone working and a 1/4 of that 1/4 are seeing clients. The rest are working away at some unseen task on a computer. There is a "security guard" who does nothing that we can see except stand there and chit chat with the receptionists.
Did I mention it was dirty? There were no pictures on the scratched, beaten up walls, nothing to engage people who are waiting - no tables with magazines, no area of toys for small children (we saw at least 3 different moms come in with children and endure the long waits). No water cooler - only big signs that say "no food or drink" with scribbling on them and the wall under them.
The other people who came and went to receive 'assistance' had varying degrees of a chip on their shoulder. Some, it was painfully obvious were trying to circumvent the system and not interested in honesty. Others just looked worn down and resigned to the process.
You check in at the initial desk and are given a number. No asking of why you are there - just get your number and sit.
You wait nearly two hours, and are then called to another desk, right next to the first desk and you try to explain why you are there, we were just trying to drop off a form. The person at the desk has no idea what we are talking about, has no idea if the other information had been faxed. We show here that we were asked to provide the information we had, and she, without comment, gives us another number and sends us to another group of chairs further back in the room to wait again.
Here we wait for another 2 (or maybe more) hours. While waiting we hear the workers dealing with some of the other people while we wait. One man is so mean to the people he is talking with that I begin to pray, no beg, God that we do not have to be served by that man. I was literally scared to go back and talk to him.
Finally, it was our turn. Initially the woman we spoke to was cold and disrespectful. I, having sat in a cold, uncomfortable chair without food or drink or a bathroom for 3+ hours and being 24ish weeks pregnant had pretty much had it. I somehow was able to stick up for myself without losing my temper, and R was able to fill in the gaps and somehow in that process we must have shown to the lady that we were not her 'usual' clientele and her whole tone changed. From being unable to help us (the default response of all the workers it seemed) to doing some research and giving us the answers we needed. We also found out that we had already been assigned a case worker (who we NEVER heard form or even received that person's name). And that we were good to go.
We were told that the information we had received that seemed skeptical was, in fact, valid and that all we needed to do was go in and select our provider and primary care doctors. That the initial process R had started (despite our not sending in the documents we were told we needed to send in) was, in fact, completed and just waiting on us to make our selections.This still baffles us - how it was possible to not provide all the "required" information and still have a case opened and active AND that when we filled out a second application process there was no recognition in the system that our information was already active. It wasn't until we spent our day at the Assistance office that any of this was clarified.
Once home and logged into the system, we were able to select our provider and chose one that was the Medicaid branch of the local Healthcare system, that was also a large hospital system (UPMC).
As we walked home, we reflected on our experience at the Assistance Office and commented how we felt like our soul was slowly being drained from our body while we sat there. How disrespectful of human dignity the whole environment was. How it would be so simple to put a few pictures on the walls, put a water cooler with cups, allow for a trip to the bathroom without fear of losing your place in line, treating people with a default position of respect, not suspicion and rudeness.
We realized that in some sense, it is a bad circular pattern, with those that come in to seek assistance not necessarily respecting the environment (perhaps there had been a water cooler at one point, but was vandalized?). But, the conclusion I came to was that those who know better should do better. Create an environment with expectations for behavior, respectfully insist those expectations be met and treat people with full respect of their human dignity.
If this is what social services and assistance in the United States looks like, and I have only reason to believe this is the norm, not the exception, then we, as a country have a lot to be ashamed of. And prior to personally experiencing this, I had no reason but to believe that it was more akin to a trip to the DMV or SS office - annoying, frustrating, but ultimately your needs are met and you are typically treated with a decent level of respect. (Not that it should be that way there, either...) The 'assistance' provided, and the manner in which it is provided only perpetuates the problem. The dignity of the person is not respected - from their time (you would need to take an entire day off of work in order to go to the Assistance office, and if you try to call, the phone rings and rings and rings and then you are given a message that says everyone is busy, call back later - not even an option to leave a voicemail) to the way they are treated (with a default position of suspicion and annoyance) to the environment they are expected to wait in.
In fact, when my divorce was final and my name legal changed back to my maiden name, I opted to not return to the Assistance office (because that was the only way to do it) and to just deal with it as described above. As I said to R: "I can't stand another day of that." Only, I am all too aware that I was able to make that choice...that there was not a NEED to return to the office, unlike so many others who must return.
I am not sure what the solution is, but what I keep coming back to is that 'those who know better, must do better' and that it is responsibility of those providing the services to preserve the dignity of those they serve.
While we were living in Pittsburgh, our initial preference was to keep my doctor in WV and deliver at the small hospital here as well. My mom worked at that hospital and while I didn't want her (or anyone besides R) present while I was in labor, I was familiar with the hospital, loved their L&D unit and their philosophy. In fact, most things that we would have requested on our birth plan were standard practice. Not to mention switching OBs at almost 30 weeks pregnant.
So, I called my OB and let them know my insurance was switching and asked if they accepted out of state plans. The lady I spoke to was rude (which was unusual) and stated that they do not accept any out of state Medicaid. She didn't offer any other options (a private pay, which we were willing to consider if the hospital would accept the PA Medicaid), and seemed annoyed that I didn't already know the answer to this question. Being that Morgantown is less than 10 miles from PA, and the closest hospital to lots of small communities in SW PA, I was surprised at the rudeness and shortness with which I was responded to. It was hard not to wonder if it was because I was a Medicaid patient now. I'd only ever been treated respectfully when I was a private insurance patient.
And so, we switched doctors. From a practice with OBs and midwives to a full midwife practice at a large women's hospital. Looking back, I'm so grateful for this. I loved the midwives, even though I only met each one once, and was introduced to 3 different ones throughout my labor, they were all wonderful. Some I liked better than others, but all in all, it was a great switch and now I find myself in the opposite situation where I want to keep them as my provider instead of the local doctors here in WV (there was a lot of turmoil at my OB practice just after we switched and I would be switching to yet another practice anyway).
Actual Care/Benefits Received
In this category, once we switched doctors, I have nothing but gratitude and positive experiences. I realize that may not be the same for everyone, but this was our experience. Maybe it was because our insurance and our hospital/doctors were all the same network. After my first visit, I didn't even have to show my medical card anymore, I was in the system.
We did have the lack of consistency regarding my last name, as described above, but each person I spoke to in that process was polite and easy to work with (all were associated with the hospital system/insurance).
As far as I could tell, I was not given any different treatment than any other patient as a Medicaid patient. I have no idea if our chart was flagged or anything like that. Never was our insurance coverage brought up in the course of treatment.
My entire pregnancy care and delivery, as well as post-partum care and all of Sugarbeet's pediatric needs until she was 6 months old, were covered completely. There were no random bills or mix ups. Everything went smoothly, and removed a great source of stress for us.
We returned to private insurance coverage when R started working last year, but for the time that we needed Medicaid, I am grateful it existed and will always be an advocate for providing support to those who need it. The process was unnecessarily complicated and disrespectful and needs to be changed. I have a new level of empathy for those with less educational and emotional resources to navigate the system, as had I not been pregnant and knew we needed help in covering the care, I would have thrown my hands up in frustration and been so tempted to take the risk of not having insurance and paying the fee for that decision.
I am not sure what the solution is. I realize there is a bad cycle happening with lack of respect on all sides. Some things that would have helped us:
- Consistency in logos and labeling would be helpful - if the paperwork we had received matched the online information, we would have proceeded.
- A reliable way to turn in and manage paperwork - why we needed to spend half a day in the office to turn in a piece of paper makes no sense to me (and the fax my OB's office sent never got there, even though it was sent to the number we were given) - and communicate what is still needed and how/where it should be submitted.
- Respectful treatment by those facilitating the government assistance - from the environment to the interactions with others.
I also realize that our experience with government assistance was limited, this is but a small snapshot of the true experiences of thousands of thousands of people every day. I would hope that those receiving additional benefits and receiving the required services of a case worker have a better experience, I'm especially thinking of those of you who are Foster Parents...I am hoping that the social workers facilitating the foster placement are able to help navigate the services you receive.
If you have had a different experience, I would love to hear it. I am not interested in a bashing of the system or only a negative reporting. This is just our experience, one small piece of the puzzle.