Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link

Abstract

In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.”¹ To identify unnecessary visits, the state proposed a list of approximately 500 diagnosis codes (see examples in the table ). The proposed rule would apply to all Medicaid beneficiaries, irrespective of age, disability, or place of residence (such as a nursing home) — even if the patient, the child's parent, or the nursing home staff believed that ED care was needed.