The expansion of Medicaid (10 million) has reduced the number of uninsured patients, but the number of emergency visits is still increasing. Contributing reasons: primary care shortages and physicians who won’t accept Medicaid because reimbursements are so low.
- Unless more options are available, it’s unfair to blame Medicaid patients for seeking emergency care. ACEP has urged CMS to increase efforts to improve primary care access for Medicaid emergency patients.
- Emergency department use by Medicaid patients accounts for 4 percent of total Medicaid spending.
- Emergency physicians are the only doctors required by law to treat Medicaid patients, and they should be compensated fairly.
- State Medicaid programs have sought to limit emergency visits and deny coverage for emergency care. However, all health plans are required by the Affordable Care Act to base coverage on a patient’s symptoms, not the final diagnosis — also known as the “prudent layperson standard.”
Medicaid Fact Sheet