A Washington state plan to limit Medicaid reimbursement in emergency rooms to patients with a set list of conditions would result in the denial of care to patients who need it, according to research released by the American College of Emergency Physicians.
ER docs: Wash. plan would deny needed care
Washington is set to implement its Medicaid plan April 1. A researcher, using data on emergency room visits in Oregon as the basis for his calculations, estimated that more than one in 10 Medicaid patients who would be denied care as a result of the new guidelines would actually need emergency care. Additionally, around one-third of the patients who would be denied Medicaid coverage as a result of the changes in the plan would need primary care within 12 hours, and an estimated 2.3% of patients with conditions that would deny them Medicaid coverage would end up needing hospitalization, according to the analysis (PDF).
"The Washington state Medicaid plan is flawed because it assumes that physicians know the final diagnosis when a patient walks in the door," said the research report's author, Dr. Robert Lowe, a professor in medical informatics and clinical epidemiology at Oregon Health and Science University, in an ACEP news release. "But many patients come in with minor symptoms that turn out to be serious medical conditions," Lowe said.
The state is selecting about 500 diagnosis codes as non-medically necessary for ER care and will not make exceptions, according to a fact sheet from the Washington State Health Care Authority (DOC). The plan is expected to save $51 million in state and federal funding over the state's current two-year budget period, which began July 1.
A spokesman for the authority declined comment.
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