The state of Washington is doing something unheard of in an attempt to keep the costs of Medicaid as low as possible. Patients will be limited to three non- emergency visits to the emergency rooms at hospitals per year. After that, Medicaid patients will have to pay out of pocket for additional visits to the ER.
At first glance, it may sound as though the state of Washington is unsympathetic to the health care needs that people who use Medicaid require. Whether or not that happens to be true is debatable. What is true is the new rules about Medicaid coverage and visits to an emergency room.
Medicaid patients will be allowed to visit an emergency room at a hospital, any hospital, for a non-emergency medical condition a total of three times per year. Medicaid will cover at least part of the costs. If the person decides to go to the ER for a non-emergency medical situation more than three times in a given year, there will be a problem.
Medicaid will no longer cover these types of visits to emergency rooms. Medicaid patients “may be asked” to pay for the extra visits out of their own pocket.
The state of Washington has created a list of over 700 diagnoses that have been officially defined as constituting an emergency. Some of this list includes : shortness of breath, some types of asthma attacks, kidney stones, hypoglycemic coma, nonspecific chest pain, nonspecific abdominal pain, and nonspecific congestive heart failure.
Hospitals and doctors’ groups disagree with this for many reasons. They feel that most patients are not going to know the difference between heartburn and a heart attack (for example), and they don’t want patients to sit at home and attempt self-diagnoses. If it turns out that they really are having a medical emergency, then precious time is being wasted.
The doctors’ groups also think that the list of approved medical emergencies sends patients the wrong message. It gives people the idea that they should stay away from the emergency rooms. There is also the potential that people who truly are having a medical emergency will stay home because they are afraid of being charged for the visit to the emergency room.
The state, however, sees things differently. In 2010, there were 46,000 emergency room visits made by Medicaid patients for non-emergencies. There was one individual who visited an ER 125 times that year. This is being seen as an abuse of the system.
The state of Washington wants to force frequent users of the ER to get their routine care from a primary care physician, instead of from the doctors who work in emergency rooms. The problem is that many doctors are refusing to see Medicaid patients. Cuts to the Medicaid program have drastically reduced the amount of payment that doctors receive for treating people who use Medicaid. This is part of the reason why so many Medicaid patients are resorting to the emergency rooms to receive non-emergency medical care.
Image by Cyndy Sims Parr on Flickr