My family member who’s is 61 is confined to a wheel chair. He is unable to stand on his own or walk. He has had two spinal surgeries and hours of PT and OT but nothing has helped much or at least not enough for him to move to assisted living.
For the past 18 months he has been Living in a nursing home in ILLINOIS, and on private pay. His income from a pension and SS covers about 75% of the costs, the shortage has been covered through savings and family. We are now about to put him on Medicaid but worry he will be denied the medical attention / services he may need. One Dr has recommend a specialist of PT, a physiatrist as his his last hope.
If He goes on Medicaid in IL he will not get any PT or OT and maybe not get the opportunities to find the last hopeful doctor.
Searching for advise on Physiatrist option and potentially a place to live long term should the end result be the same.
Also assurance that Medicaid will help pay for services.
So you say he has not yet seen the physiatrist yet in IL? Can you find one now while he is commercial pay? Chances of Medicaid providing that specific level of treatment by a psysiatrist are next to none. PT...yes.
Each state has it’s own Medicaid program and all differ. I would call Illinois Medicaid and ask them what will be available to him while on Medicaid.
OP, why not a physical therapist? A good physical therapist is on par with a physiatrist. I have worked with wonderful PT’s in the past - caring, knowledgeable folks who really work with the patient to achieve their highest level of function. Both are educated in muscles and how they work.
Once a person leaves commercial pay status and goes to government HC providers (Medicare but especially Medicaid) the entire pool of providers changes and decreases. Many providers decline to take Medicaid & Medicare patients due to low reimbursement rates.
I’ve had 2 back surgeries - one at 22 the next at 57. The last was a lumbar fusion in 2015. I am 62. My surgery was fortunately very successful but I researched and sought out my surgeon and knew the quality of his work from taking care of his patients while being a HC nurse. That surgeon saved my mobility. He told me afterwards that I will never need surgery there again. I believe him. My issue is healed except for sciatica and I have learned to live with that. Gotta love arrogant yet very qualified orthopedic surgeons. I don’t mind arrogance if performance backs it up. His did.
Good luck!
Generally, a physiatrist does diagnosis and design of a treatment plan to be carried out by a PT. A Physiatrist does NOT do therapy.
Has someone told you he can't get certain services once on Medicaid?
I know a person who is in a NH who NJ Medicaid is paying for him to have gastric bypass. He has been taken to specialists, had all the tests and I would think a Psychiatrist to make sure he mentally can go thru what is needed.
Medicaid will not pay for an AL. LTC and in home waivers they do.
Has your friend applied for Social Security Disability? That would give him Medicare and Medicaid for health insurance. If he hasn't, maybe too late now since he is so close to 62 when he can apply and get 75% of what he would get at 66/67.