raisel-the-riveter replied to your post "i love singers who change a note* for a live s...
I love when they do this and it makes the song more singable and then I can sing the live version decently instead of squawking along w the recorded version
How does insurance Bucky feel about the IMD exclusion's impact on Medicaid HCBS?
Sir, he’s unstable, erratic… he’s been out of cryofreeze too long…
These are things that Bucky knows:
Steve got a folder, once, from the Widow. There was information in it, though not a lot. On the inside cover, there was a photo of Bucky asleep in a cryotank.
Steve made some assumptions, at that point. Bucky’s pretty sure Steve has shared these assumptions with the others. There have been mentions of ice, and cold, and, from that asshole Stark, some unfortunate jokes about the Russian winter.
Bucky doesn’t correct them. Or, he didn’t used to. It didn’t really matter.
But these are things that Bucky knows:
The year was 2004, and he was in the another hospital.
(Maybe it was 2013. Maybe it was 1996. Maybe it 1982.)
(It’s not that he can’t remember. Bucky has a great memory, except for the blank spots. It’s just that time blends together when there’s nothing on either end.)
That particular hospital had 177 beds. One hundred and seventy-seven slots for men and women, children and elderly, to use if they needed to be crazy for a while. Most people would come and go, never really staying long. Bucky wasn’t one of them. Bucky tended toward visual hallucinations, violent tendencies, a persistent belief that he was born too many years ago — and he became utterly paralyzed when anybody mentioned that old WWII legend, Captain America.
No, Bucky was very definitely some kind of unhinged. He couldn’t even talk about how he’d come to lose his left arm. He tended to just look at the empty space and start trying to convince that staff that he did have an arm, the men just took it from him all that time so no one could see it… Or, at least, that’s what he did on the days that he didn’t just start crying instead.
Bucky remembers this stuff. How the cryotank wasn’t actually the best technology on the planet, and after awhile some bright little egghead in the 1960s thought it might be easier to kill two birds with one stone by putting the Soldier into a psychiatric care situation, both to get the opportunity for more experiments and brainwashing bullshit and to get time to tinker with the tank. How that was the start of Bucky skipping his way from hospital to ward to institution to hospital again, with brief stops to test out another version of the tank, or to “affect the course of history” blah-de-fucking-blah, before being pulled out and shoved into the system again.
Bucky also remembers being crazy. Being told that nothing he knew, nothing he believed, nothing he remembered, was real. What it felt like when even the very few nice people he came across would tell him those things. (One of the upsides to HYDRA was that, if nothing else, it was a pretty great confirmation of at least a couple of his memories and beliefs.)
And it’s not like Bucky’s all that different now. He knows Steve’s alive — that solved one of his problems right there. And nobody tries to tell him that his arm doesn’t exist — they’re all very much aware of it, which is good. He still has hallucinations, and violent tendencies, and a persistent belief that he was born too many years ago, but one of those is true, and he’s lived long enough with the other two that it’s just, like, a thing. Whatever. He’s the Winter Soldier, he has an excuse.
But these are things that Bucky knows:
He reads a lot now. At first, it was just stuff Steve had around. Then, it was whatever JARVIS recommended, based on recent discussion topics or biometric pressure readings or the moon, who knew.
Now, Bucky’s reading the presentation materials from January’s Medicaid and CHIP Payment Access Commission’s public meetings. He’s reading them in order, because it’s not about cherry-picking information — it’s just about having it, that’s what he’s interested in.
The next one down is titled “Medicaid’s Role in Behavioral Health: Background and Policy Issues,” and there’s a phrase in it that he doesn’t know. “IMD exclusion.” He goes and types it into Google. Thanks, internet.
Steve comes back an hour later, and Bucky is looking out the window, the laptop forgotten on the floor.
"Buck?"
"Institutions for mental disease are specifically prohibited from receiving matching funds from Medicaid to treat people between the ages of 22 and 64, often leading to a limited number of choices among available institutions that will even accept that population and a likely compromise of quality of treatment. Additionally, one of the unintended consequences of the IMD exclusion is that people in that age group are also prohibited from having Medicaid while in treatment, to the point where if they have a major medical problem unrelated to their mental one, they have to be discharged from the IMD, reinstated to Medicaid, receive treatment, and then be readmitted to the IMD."
Steve steps closer. “I don’t understand,” he says quietly.
The window is showing Bucky scenes from 1924, mixed up with ones from 2004. There’d been a guy who looked like Steve in the next room over. They saw each other sometimes. The guy had sepsis from, Jesus, something. Probably trying to wedge the corner of his bed through his hand; the guy had a body thing. He and Bucky talked about body things, sometimes. The way anybody talked about anything.
So the guy got sepsis. He left. And he was crazy as shit, just as crazy as Bucky, but he never came back, and for the longest time Bucky thought maybe it was because he’d gotten better. Or died. One of those two options, either of which would be a dream come true for Bucky back then.
And now… now he doesn’t know what happened. He got out, sure. But maybe he couldn’t get back in. One hundred and seventy-seven beds. All of them filling up fast. (Not everybody had HYDRA to guarantee a spot. Not everybody was as lucky as Bucky.)
There are a lot of places to end up, when there’s no place at all to go.
Bucky looks at his flesh hand and says, “There are home and community-based services available through Medicaid, for people of any age group. They were created as a move toward deinstutionalization and to prevent funding the warehousing of psychiatric patients by the state. If the IMD exclusion is removed, there is a concern that the increased load on Medicaid’s budget may lead to a decrease in the services many depend on. “
Steve sits on the floor near Bucky, a trick he learned from Sam. Bucky’s known about it for longer than that. “So… people don’t want the exclusion to be removed, is that it? Because the home and community services are part of the solution to getting people out of those institutions, and without the exclusion, there’s no incentive?” Steve tries to smile. Like he’s pleased about figuring something out. Bucky wants to shake him. “It, uh, doesn’t seem like a bad thing to keep people out of institutions,” Steve says. “Keep people with their families, or… not with strangers.”
Bucky looks at his metal hand, now. “Family,” he says. “Steve,” he says.
These are the things that Bucky knows:
"Steve," he says again, "where would I be if I didn’t live here, with you?"
Steve looks surprised by the question, and then— an emotion. It’s definitely an emotion. Bucky’s not sure which one, they’re hard to tell apart. “But you do live here,” he says, pressing the words. “That’s what’s important.”
Bucky looks up. He looks at Steve. He looks at the little guy with sepsis who’s standing in the corner. He looks at Pierce, who’s pouring a glass of milk. He looks at the dog that he’s pretty sure no one else can see, but that Bucky’s named Aoife because he’s always wanted a dog. Aoife turns her back to him.
Bucky twitches, and a spiderweb forms in the unbreakable window his fist just tried to smash through.
