Any Experiences With Chronic Pain and Medicaid?

[Eva 14]

I suffer from excruciating chronic pain, but at least I've found a great doctor who is willing to help me. Of course, doctor visits, health insurance, and medications are not cheap. You get what you pay for, I believe. And I am very skeptical of any program run by the government. I've heard there's tons of red tape, long waiting periods, and that you are treated like a number, not a person. And that you have to go to County Hospitals and government doctors. It sounds horrible!

My chronic pain makes it impossible for me to work. I recently discovered that a person has to make at least $17,000 a year in order to qualify for Obamacare, so I don't even qualify for that.

A friend of mine suggested I try Med-Cal, but from the stories I've heard, it sounds like being a chronic pain patient on Medicaid is a nightmare. Am I right about this? Does anyone have any experience or stories to share?

Of course my pain doctor does NOT take Medicaid, so I'd have to pay out-of-pocket for my doctor's appointments. (I basically already do that, since my PM doctor is not a preferred provider on any insurance plans). If I was on Medi-Cal, I'd still have the option of paying cash to see my private doctor, right? Or not?

However, I'm really worried that Medicaid would never cover the expensive pain medications that I have to take. I take Exalgo (long-acting Dilaudid), which would cost several thousands of dollars a month without insurance. I also need to take Dilaudid suppositories and phenergen suppositories for nausea. Each of these meds would also be VERY expensive without health insurance, even though I'm taking the generic versions.

I googled the Medi-Cal drug formulary and it looks like none of these 3 meds is covered. Medi-Cal only wants to pay for very cheap drugs. I'll bet that their quantity limits are pretty restrictive, too. At least my current health insurance allows me to get the meds I need, in the proper amounts.

So is my only choice to keep paying expensive premiums if I want to continue to receive the meds that I need just to function at a basic level? It sounds like it, unfortunately. They keep raising my premiums every single year, which is so distressing. I don't know how I'm going to be able to afford this health insurance for the rest of my life, but I really have no choice.

It just seems so unfair that healthy people who are able to work get great FREE health insurance, but they never even have to use it. Friends and relatives I know have great FREE health insurance, but they never even go to the doctor, never go through their deductibles, and never need to fill any prescriptions. Yet those of us who are chronically ill and unable to work have to pay so much for health insurance, doctor's visits, meds, etc. I basically feel like I'm being penalized for being ill.

Am I correct that Medi-Cal/Medicaid is NOT a good choice for CP patients? (I know that some people have no other choice. You have my sympathy.) Does anyone here with CP have experience with being on Medicaid? What is it like? Do they refuse to cover the meds that you need and impose crazy restrictive quantity limits? Are you allowed to see a private doctor? All I've really heard are horror stories. Is it as bad as everyone says?

Thanks,
Eva

[alex44]

Eva = We are here in Arizona, and are both CP patients. There are PM docs as well as PM that will take Medicaid, they are just hard to find - but Medicaid here pay's for all drugs too. I am not sure about the formulary but one could check or go to a less expensive
med - yes, I know it stinks but ii have both the VA and Medicaid - I am undermedicated, none will give me an increase, and yet I feel lucky for what I do get. Hang in there - I don't see that you have anything to lose by signing up with Medi-Cal. Warning - IF you use anything the Federal government considers illegal will result in no pain meds or being cut off. things may be legal on a state level but not on the federal which is their excuse to say NO.
blessings
Alex44Skypilot

[Eva 14]

Alex, thanks for your reply. Thanks for the 'heads up' about Federal policy, too. It's very easy to get a MMJ card here in California. My private pain doc gave me a prescription for MMJ. (Turns out MJ doesn't work for me, so I don't use it). Still, I definitely support the right of others to use MJ.

My pain doc obviously wouldn't care if I tested positive for MJ, since I have the prescription from him. But if a person is on Medicaid, are they required to go to a government doctor? So even though medical MJ use has been legal in Calif. for 20 years, a Medicaid doctor might view things differently and refuse to prescribe pain meds if a patient tested positive for MJ? Sadly, I can believe it, due to all of the misguided "War on Drugs" hysteria.

I guess Federal law always trumps State law? People have to choose to use either MJ or opiates, but cannot use both? Thanks for the warning. I know that the DEA couldn't care less that pain patients are suffering. The difference between US Federal law and Calif. State law regarding MMJ is huge.

[alex44]

Eva - to try to answer your question, a federal doc, (Medicaid Doc has choices. he/she does not have to require a PM contract at their option, in which case you may be tested but there is no penalty involved if you test positive = and there are a few that may ask you to sign a contract but it comes down to a Don't ask/ Don't tell policy. If you want to discuss this in depth, PM me where I can talk more freely. and finally, you are not required to go to a Medicaid Doc. but it can get pricey Best of luck and I hope you are doing better.
Blessings
Alex44Skypilot

[snapdragon928]

I am on medicaid. I take lyrica, roboxin and norcos. I need to call the Dr because since I dropped the mscontin I am in terrible pain. I have used two norcos but then I run out before the end of the month. I got sent to a pain Dr that was rinky dink, one Dr and one nurse and they did nothing for me but put me through a painful nerve test. Once he learned that I was having surgery on my back he was done with me. I hope you have good luck. I go to my neuro surgeon next week but I am calling him to see if he can up my meds because of the pain. There are limits. I have left over tramadol and left over gabapentin that I have enlisted as a back up plan. When my pain meds run out. I did take a gabapentin with my lyrica and norco and roboxin last night and this morning, because the pain is just so bad. But they may make some changes to my pain meds I hope. They cover lyrica. I don't know what else they cover. I had spinal stenosis and bulging discs and bony growths. I have DISH syndrome and central pain syndrome. I have arthritis too. I had back surgery one week shy of two months ago. The medicaid has covered everything thus far but drs check the formulary first usually. Good luck. I can't work so medicaid is my only choice I am on disability.

[snapdragon928]

I would consider MMJ but from my understanding that isn't covered and I don't know if I would be cut off my pain meds if I tried it. They randomly take urine samples at my drs office. I would like to try it but I don't even know where to start or how I would afford it. I am in AA too and they frown on that.

[Earth Mother 2 Angels]

((((((snapdragon928)))))) ~

Is it possible to have a conversation with your physician about the possibility of you trying MMJ for your pain? If not, are there other physicians in your area, who would be open to having that conversation with you?

The unnecessary stigma attached to cannabis is probably preventing millions of people from relief. Cannabidoil (CBD) is now being shown as effective in treating seizures in children (and now adults), as well as patients with autoimmune disorders, such as Rheumatoid Arthritis and Multiple Sclerosis. There is no "high" attached to CBD. So it doesn't deserve to be shunned by doctors or other medical professionals, or AA groups.

It's okay to take narcotics for pain, but not CBD or MMJ? That just seems hypocritical to me.

My son takes 3 different drugs, one, Phenobarbitol is a barbituate, to control his seizures. If I could have started with CBD oil with him, I would have joyfully done so. All of his pharmaceutical meds have serious, life threatening side effects. CBD oil and MMJ have none.

But the manufacturers of those three meds stand to lose a lot of money, if CBD oil and MMJ can treat conditions more effectively and safely than their drugs. And doctors get perks and cash from these manufacturers, so they are reluctant to agree to a natural alternative.

What most people don't know is that many drugs are derived from plant based medicines. For example, one of my son's seizure meds is Valproic Acid, derived from Valerian Root, a naturally occurring plant. Valproic Acid is chemicals combined to mimic Valerian Root. Had I known this in the beginning, I would have given him Valerian Root.

Perhaps you could search for another doctor to treat you. Or visit a Naturopath. And if you decide that you want to pursue MMJ or CBD oil, then do some Google searches to see what is required for you to do that in your state. Gather some information and be your own advocate for your health. This is your body. You're the boss.

Love & Light,

Rose

[alex44]

To All - what i said before is only to true - i Know how the VA blathers on about it is ok to get the card and smoke but try it. They are under a GAG order to NOT even discuss it with you. My nurse practioner ( it seems I am not worthy of a doctor) has told me, I have a choice, the Pill's or the MMJ. To her credit, she does not test often. I suffer from Hep C., Anxiety disorder, PTSD and other ailments. I DO NOT SMOKE - I am too afraid, too afraid to go to her for what could have been a broken arm due a fall, for fear she would say I am on too much. Very severe bruising and pain out the ying/yang. I have full range of motion. and full flexation of the wrist = i am thinking bad bone bruise. Yes i have medicine as my avocation and have worked as a rescue squad woker,(for those of us old enough to rememer what a rescue squad was,) as well as Paramedic training. the VA is a nigntmare and the hospitals are not much better. So i just hope for the best, i still drink to dull the pain, Trying to quit because of th C, i have beaten harder things but this one is a real SOB. Wish me luck. I am a minister, I will pray for you and yours, take card.
Blessings
Alex44
Skypilot

[algosdoc]

Marijuana has been shown to help reduce certain types of neuropathic pain, but most types of pain it is ineffective as a pain reliever, instead working to mask the pain by producing euphoria or sedation depending on the strain used. CBD is available on the internet without a prescription, and the oil has been shown to help some with RA.

[alex44]

Very true
Blessings
Alex44
Skypilot