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Originally Posted by lizthefiz
I am just curious as to why Terri was eligible for Medicaid.
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I don't know all the rules regarding medical insurance. I spend a lot of my time arguing with mental health insurance companies at work, though.
I will, however, as is my habit, make some guesses that may prove entirely wrong.
Medical Insurance plans have levels of coverage ... they will pay so much per incident, so much per year, and so much if treatment is provided within a particular period of time.
With a catastrophic illness (which can be anything from a condition like Mrs. Schiavo's to cancer to kidney failure) it's not unusual to exhaust private medical insurance benefits.
When a person is disabled by an illness, it becomes possible to seek disability benefits, which can include things like a person under the age of 65 filing for and receiving Medicare (federal) Insurance.
You can exhaust the lifetime benefit your medicare coverage. There is also something called being a 60/60 violator ... if you spend time in inpatient treatment, you have to be OUT for 60 days before you can have another covered event. For most folks this is not a big deal, but for someone with a chronic illness, you are SOL.
That's where Medicaid comes in ... you can file for state benefits as well.
There are other funding streams beyond that, but may not apply in this situation. There is a lot of unfunded care given in all kinds of hospitals. And the hospitals have to eat this. Some years nonprofits are more nonprofit than they should be. Unfunded care is different from Charity care .... these are people who are given services that can't get any kind of coverage or funding. Folks who exhaust their regular insurance benefits are a full billing liability (i.e., a true loss) to the hospital. But, interestingly, you can't refuse to admit someone, or toss them out on their asses just because they don't have insurance benefits remaining ... because if you don't provide the care anyway you risk no longer being able to bill for any medicare payments,
even if that patient didn't have medicare to begin with.