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.