“I always wanted to be creative, but I had four kids to raise, then I had my mom,” she said. “And now I’m trying to survive.”

Tia Mitchell Tampa Bay Times

A frustrated doctor

Dr. Saurinkumar Shah has a complicated relationship with Medicaid.

On one hand, it is his bread and butter. He estimates that 70 to 80 percent of the patients at his single-doctor family practice, Trinity Family Health Care, are on Medicaid.

He takes pride in treating entire families, along with the elderly. He says he can meet just about all of their medical needs, anything from routine checkups to common illnesses. It’s the type of work that pays the bills but won’t make him a millionaire.

“I am very well satisfied,” he said. “I am sleeping at night time.”

When he was a little boy growing up in India, his grandmother told him that he would become a doctor. He has been passionate about pursuing medicine ever since.

But being a Medicaid doctor is often a pain.

“To deal with Medicaid is not easy,” Shah said. “Medicaid has its own rules and it has its own problems.”

For example, Shah only gets paid for services rendered to Medicaid patients. However, he has been assigned hundreds of people that never come in, not even for a checkup. Meanwhile, the government caps the number of Medicaid patients he is allowed to treat.

He would like to hire a nurse practitioner to assist him but can’t afford it. Instead, Shah employs three medical assistants to run the office and help tend to patients.

In Pasco County, sometimes he has difficulty finding specialists who are willing to treat Medicaid patients with serious ailments. Recently, he had to ask a doctor in Tampa to perform a biopsy on a Medicaid recipient with oral cancer as a personal favor.

The Affordable Care Act does have a provision designed to make Medicaid more lucrative for doctors. As of Jan. 1, states are supposed to pay primary care physicians the same amount they pay doctors who participate in Medicare, the government healthcare program for seniors.

“That is what I’ve heard, but I have not seen it,” Shah said.

Even so, money is not his main complaint. It’s the abuse Shah sees. For every patient that he feels is truly needy of government assistance, there are two who are bilking the system.

Shah believes Medicaid should require more accountability from those it serves.

“Make patients responsible,” he said. “Don’t think this is a freebie in the name of the poor.”

For example, patients are supposed to pay $2 co-pays per visit. Many of them balk at that cost and refuse to ante up. There are no repercussions.

There should be education programs, Shah says, that urge Medicaid recipients to wait to see primary care physicians instead of rushing to the emergency room when they’re not feeling well. The government should cut off those who are taking advantage.

He believes the purpose of Medicaid is noble. But what is actually happening, the “big, black hole” as Shah calls it, can be far from that.

Tia Mitchell Tampa Bay Times

A mother with a difficult choice

Nancy Fraze quit waitressing last year after a letter from the government led her to this conclusion:

Her two children, especially her chronically ill son, are better off if she doesn’t work.