Latex gloves illustrate frustration with Medicare and Medicaid

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by BYRON HARRIS

WFAA

Posted on September 5, 2012 at 9:06 AM

Updated Wednesday, Sep 5 at 12:14 PM

Medicare and Medicaid are two of the hot button issues of the political season.

Some people want to cut these programs; others want to leave them untouched.

Seven million people use Medicare and Medicaid in Texas. And while no one wants to lose the benefits, there's a lot of frustration with the way the programs work.

Twenty years ago, Frances Moore had a paralyzing stroke. Her daughter Nancy has been taking care of her ever since.

She watches as her mother's skin tears become more frequent, and watching health care change.

Medicare? Frances is on that.

Medicaid? Because they're poor, she's on that, too.

Managed care? Because Medicaid is now a managed care program run by a company, Frances is also on that.

Frances Moore can't live without Medicare and Medicaid. But Nancy Moore will tell you that sometimes, it's hard to live with them, too.

Especially lately.

"Cuts. Cut anything, cut everything. Deny, deny, deny. If you present evidence that your claim should be honored, they just change the subject. They say stuff that doesn't make sense. They go down the rabbit hole," Nancy Moore said.

The "rabbit hole" in this case is a box of documents that Nancy keeps, studies and memorizes. A box on fire with contradictions within Medicare and Medicaid... over what the plans say they'll provide (as opposed to what they really provide).

 Case in point: Latex gloves... a few pennies a pair.

"They're commonly called, in the industry, 'universal precautions,'" Nancy Moore said.

She would like to get gloves from Medicaid, because she changes dressings on her mom's cuts, cleans blood off the floor, and changes her diapers.

"Gloves are cheap," Nancy said. "They reduce further cost because they reduce infection."

Gloves used to be covered under Medicaid, but no more... even though Nancy has found contradicting policies in three Medicaid handbooks.

"I think the main thing that has changed is the interpretation of the rule book, and inconsistencies interpreting the rule book," she said.

On the other hand, there's barrier cream, which Frances Moore doesn't need. ""hey give us this stuff, oh yeah," Nancy said.

Frances has a potty chair, which Nancy got with the financial help of a neighbor because she feared her mom would fall in the bathroom and hurt herself.

Her Medicaid managed care organization offered to build a new bathroom.

"They were going to demolish the shower, put in a brand-new shower, tear out walls, put in a new floor," Nancy said. "I said ultimately, none of that really changes her access to the bathroom."

Medicaid's solution cost $3,000.

Nancy's solution was $80 out of pocket.

On any given day at the Scenario Adult Day Care Center, Elizabeth Perez has dozens of Medicaid patients like Frances Moore. She needs gloves, too.

"When it comes to the family member, then they have to do without," she said.

But should gloves be included? "Absolutely," Perez said. "It would be very helpful."

Nancy Moore sopped up her mom's blood to appeal her case for gloves to her managed care organization which runs Medicaid.

The appeal was denied.

Nancy Moore and Elizabeth Perez share the same frustrations and fears for the people they care for.

They don't want Medicare and Medicaid to go away; they just wish it all made more sense.

E-mail bharris@wfaa.com

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