2.4% of Kentucky Medicaid’s emergency-room costs in 2015, or $9.3 million, were for non-emergency cases
About 36 percent of Medicaid recipients visited an emergency room last year, according to data Eric Flack of WAVE-TV obtained from the Cabinet for Health and Family Services. Of those visits, nearly 200,000 of them were for non-emergencies, “things that could have handled by a regular doctor, saving taxpayers millions,” Flack reported.
Kentucky taxes pay about 30 percent of the bills of traditional Medicaid recipients. The federal government pays the rest, and through this year pays the full cost of those in the 2014 expansion of the program.
It’s unclear at this point how the 2015 figures stack up to those from 2014, the first year of then-Gov. Steve Beshear’s expansion of Medicaid eligibility under federal health reform. That has added about 440,000 Kentuckians to the Medicaid rolls.
Flack’s report was based solely on the 2015 figures, with no further context, and he did not mention that the $9.3 million figure was 2.4 percent of the total.
“Taxpayers spent around $300,000 in ER visits for various forms of rhinitis, or runny nose,” Flack reported. “Even when it’s caused by the family pet. Medicaid users come to the ER for cramps, insect bites, sunburn, acne. They come because they can’t quit smoking. They get emergency treatment for a headache after sex.”
Why do many Medicaid recipients seek care at an ER for a non-emergency? Lack of information, say people familiar with the program. Medicaid recipients make a co-payment of $8 for ER visits, so if the person seeking care is someone who has never had insurance before and doesn’t understand how to choose the most effective outlet for treatment, or has not obtained a primary-care physician, that person may rely on the local ER for non-emergency medical care.
Passport Health Plan and Humana Inc., two of four managed-care organizations that deal directly with Medicaid members, had drastically lower rates of non-emergency visits to the ER than did Aetna and WellCare, according to state data from Flack reported.
Michael Rabkin, communications director for Passport, said that could be because of the company’s educational programs and staff. Passport employs embedded case managers who work with patients and doctors to inform patients of alternative options to the ER, such as urgent-care clinics. The case managers also encourage patients to practice preventive care and schedule regular doctor visits to decrease costs and treat health problems before they become critical. The company also offers a free nurse hotline that allows patients to call with medical questions, day or night, seven days a week.
Republican Gov. Matt Bevin’s proposed changes to Medicaid are expected to be filed this month. One of his suggested changes is a $75 fee for expansion members who use the ER for non-emergencies. Traditional Medicaid users would not be subject to the fee.