Medicaid: I’m Sorry, Did You Want Social Services With That?

While doing some unrelated research for work recently, I happened upon some information about Medicaid transportation services in Oregon which I found rather fascinating. And also rather annoying. Medicaid will, it turns out, pay for medical transportation for appointments covered by Medicaid (of course, this assumes that “transportation” can take any number of forms, including buses, taxis, and so forth), if other options aren’t available and the recipient is “eligible.” This does not include transport for medical appointments and evaluations which are not covered by Medicaid; you’re on your own there, apparently.

And, while I would hope that Medicaid would not, say, force a wheelchair user to use transportation which is not accessible by wheelchair, I could see them forcing someone with social anxiety to take the bus, or insisting that someone with PTSD from a traumatic car accident take a taxi, even if this is triggering. Let’s not think that Medicaid would be too generous, here, when it comes to covering transportation.

What’s really interesting to me is Medicaid’s approach to non-medical transportation.

Non-medical transportation falls into the category of anything not related to medical appointments and medical care. Which includes things like buying groceries, attending school, taking yoga classes, going to social events, heading to work, whatever. Living your life, in other words. Medicaid apparently will cover some types of non-medical transportation, for “certain” clients, although the site doesn’t go into detail about who might qualify for this magnanimous benefit. Which is, honestly, more than I would have expected of them, although it’s less than Medicaid should be doing.

The framing of this informational page intrigues me. It seems to be stressing that people should try to arrange for themselves whenever possible; it assumes, for example, that people will/should get prescriptions by mail, or that they should rely on their friends for transportation, including medical transportation, with transportation being covered only grudgingly. Presumably it also thinks that people should always order groceries and other things they need for delivery, rather than going out, and that people on Medicaid should not do things like going to dance classes or socializing at the coffeehouse or going to work or anything, really, other than sitting at home.

It’s also important to note that paid transport has to be preauthorized. People should not assume, in other words, that Medicaid will pay for transport.

This seems to me to be a deliberate ignorance of class issues, and of day to day life for people with disabilities.

It’s a class problem because it assumes that most people have friends with cars (and schedules flexible enough for them to take time out of their day to provide transport), and because it assumes that everyone has access to safe, accessible transit. Neither of these things is the case. In fact, for Medicaid beneficiaries, both of these things are actually seriously in question. Friends might have cars, for example, but they might not be safe or accessible. Or those friends might not be able to provide transport when it’s needed. Likewise, assuming a bus route goes close enough to get someone where ou needs to go, that doesn’t mean the bus is safe.

A friend might be able to go along on the bus ride for safety and to help carry things, but not necessarily. Again, friends might not be able to take time off from work to accompany someone to a medical appointment. Or friends might have very limited schedules, which means that if an appointment runs over, the friend has to leave. Even if that means that there is now no safe ride home.

And, of course, it ignores the fact that some people with disabilities are isolated, and that many of us are running out of favors. When you’re temporarily sick, friends are usually willing to pitch in and help out. They imagine themselves in that position and they figure what goes around comes around. But when you are disabled, and you have been for years, friends are less and less willing to help out. They’re tired, you’ve drifted apart, they feel like they’ve already given too much. In turn, there’s awkwardness when it comes to asking people for help when it feels like one is always asking for help, and when you’ve been constantly reminded that you need to be a good cripple and be nice and well behaved and not be a bother.

And that means that no, it’s actually not at all reasonable to demand that Medicaid recipients ask their friends for rides. It’s also not really reasonable to insist that they restrict their social lives because non-medical transportation is only available for a limited list of things. Medicaid focuses on providing the narrowest and most limited set of benefits possible, and on denying those benefits whenever it can see a way to do so.

That contributes to isolation in a pretty major way. If leaving your house is a huge production which involves a great deal of work, you’re less inclined to do it. And that means that you are less inclined to spend time with other people, to attend events which look interesting, to do things that you want to do. And, of course, over time that means that your friends assume that you can’t leave. Policies like this effectively trap people in their homes.

That’s not social services. That’s just injustice.


  1. Isn’t it ironic to notice how social service systems everywhere seem to assume that every person they serve, has friends; while at the same time, social services exist to help the most vulnerable people in society? And, when you try to build a social life, you run into barriers put in place by agencies that apparently presume you got all of these friends out of mid-air. It’s the same here. We have this transportation system for the disabled, but unless you are in “exceptional” circumstances, you are only allowed 750 km per year at its low rate (if you need to use it more, you get to pay a “non-commercial” price, oh wow). That way, if I used this system to visit my parents 220 km away, I couldn’t even visit them twice a year. (I don’t use this system at all because the cabs it employs are highly unreliable, so that using public transportaiton is less of a hassle for me.)

  2. Ohhh yes yes yes. There’s also the issue I have: although I do have quite a few friends, most of them are, wonder of wonders, also non-drivers. And the ones who do drive, as you hint, often have busy schedules.

    And there are a couple other assumptions. That transportation actually goes to one’s home as well as where one needs to be, when one needs it. (The weekend bus route to my apartment, for instance, only runs when the university semester is in session.) That groceries and medications can be delivered (there’s no grocery delivery where I live, and some meds are cheaper to pick up in person). And so on and so forth…

  3. This always sets my teeth on edge. The fact that public assistance programs just take for granted that those receiving their services have access to bottomless wells of friend and family support, and that they shouldn’t have any conflict of pride and dignity whatsoever to tap them, is one of the things that outrages me most about The System. I’ve had so many health care professionals treat me like the world’s biggest idiot because I didn’t ask my parents to pay for something to do with my treatment. They stare at me in shock and disgust as though I’m defying them to comprehend why I wouldn’t want to suck every last penny from my family.

    I had a friend once whose therapist asked him why he didn’t just ask his parents to pay for his medication if he couldn’t afford it. He said, “Because I’m 45!”

  4. Yep, everybody has friends with loads of free time, don’t cha know? I’m lucky that my caseworker comes to me and can drive me to medical appointments. I don’t know what I’d do otherwise, becuase my parents can’t always be there.

  5. Hello! First comment here. I love the blog and I’m so glad I’ve found it. 🙂

    As for this: “…I could see them forcing someone with social anxiety to take the bus”

    I can see it, too, because I have SAD and depression they tried to do that to to me to get to my psychiatrist’s office. Even if I was willing to ignore my discomfort to take the bus, there isn’t one that passes by where I live. I’d have walk over a mile in whatever weather to get there and back, which I don’t have the energy to do, and would make me feel very unsafe. Lots of wooded areas.

    So, right now I’m lucky and have access to a car through a family member. But I do tend to worry a lot about how long that will last, and what I will do when I don’t have access anymore. Gotta love Social Services. 😐


  6. Oh goodness yes. I am running into this one right now, having recently been laid off from the only job I’ve had since college (which I finished in 2002). I had a transportation arrangement for this job that “worked” in that it happened to be on the way to my partner’s workplace — but now as I start looking for other jobs, I am realizing just how limited I am in what positions I can even think about interviewing for, let alone considering, simply because transit coverage is so spotty around here. And because I am one of those autistic people who would probably be considered “very high functioning” by the sorts of folks who use those designations, on account of being able to type comments like this one (among other things), I know it’s highly unlikely my inability to drive or easily arrange transportation logistics would be taken seriously by any local agency, Medicaid or otherwise. In general I think transportation is a huge issue that VERY often gets ignored, not just in service provision but in society in general (or at least the middle-class American society I’m most familiar with). There is this massive assumption that everyone can drive, or at least get rides easily, or that buses go everywhere we need them to go, when we need them. When none of that is even remotely true. I am still trying to figure out what I can do about this, on behalf of myself and others alike but have yet to determine anything really useful. :/
    .-= AnneC´s last blog ..Busy, Tired, and Oh Yeah, Kittens =-.

  7. AnneC wrote: There is this massive assumption that everyone can drive, or at least get rides easily, or that buses go everywhere we need them to go, when we need them. When none of that is even remotely true.

    YES. This is one of my big pet peeves of late; I’ve encountered this assumption even among progressive groups that really, really should know better… Even groups dealing with poverty didn’t bother to think that their events were being held at transit-inaccessible places or times, or that they might want to potentially help out by having those in the org who could drive carpool. Yeah, this has induced more than a few facepalms from me.

  8. Oh, as for that last comment, one case that particularly sticks in my mind: One local org, which shall remain unnamed, decided to hold an appreciation party downtown on Labor Day for all the low-wage service workers in the area. It’s a completely appropriate day for the event… but because it’s a federal holiday, there’s no bus service running. And the people running the event didn’t even think about this fact, if I recall correctly, until I explicitly mentioned it to them several days before the event.

  9. What’s really ironic is that Medicaid, at least here, makes it nearly impossible to get my meds by mail, because they’ll only authorize 1 month of them at a time. And the bus service is laughable. They really need to admit to the fact that most US towns and suburbs, which is where a lot of people live, were not designed for nor do they currently have the infrastructure for any sort of decent public transportation.

    And as far as that goes, if I relied on public transportation to get to my PT appointments (which, oh hey, looky there, are twice as far from my house as they could be, because my Medicaid doesn’t contract with the closer place… FAIL), I’d have to leave an hour and a half early AT LEAST… no, wait. I couldn’t use public transportation because it doesn’t actually go to the PT site. And if it did, I’d be even MORE wiped out after navigating the hellacious system around here, which means I’d be completely useless for at least the rest of the day, if not several days after. On top of the fatigue from the PT, which is every other day. Which would snowball and throw me into a massive flare. No, there’s no way this plan could go wrong!

    (Crap like this makes me extremely sarcastic.)