Medicaid Reform Proposals and their Impact on Emergency Medicine
Two major concerns have come to light in regards to Medicaid reforms currently being discussed on the National level that could have a profound impact on emergency department care. Emergency Departments serve as the nation's health care safety net and play a critical role as first responders in homeland security, but this safety net is under considerable strain.
Co-pay for non-emergency care provided at emergency departments:
This idea was included in the National Governors Association's draft Medicaid reform proposal. A co-pay would be charged to Medicaid recipients who receive care in the emergency department that is determined to be non-emergent. While we recognize efforts to reduce unnecessary care, co-pays for emergency care cannot be implemented in practice because
Unintended consequences of other Medicaid reform efforts:
The Maryland Experience:
During the 2004 Legislative Session language was included in the FY2005 budget that a $10 co-pay be collected from "Medicaid recipients 21 years old or older who present to the hospital emergency room for non-emergency services". The co-pay amount was later reduced to $6 when the state found out that was the maximum that could be collected.
Ultimately the effort in Maryland to collect a co-pay failed. During the course of discussions it became readily apparent that the burden of administering and collecting the co-pay was going to far outweigh any potential benefits. The co-pay has since been taken off the table as the issues began to emerge such as: how will it be collected?, who will make the determination as to what an emergency is?, and the fact that requesting a co-pay prior to providing care violates federal EMTALA standards.
Information provided by the American College of Emergency Physicians (ACEP) and the Maryland Chapter, American College of Emergency Physicians (MD ACEP).