Cal­i­for­nia ER use jumps de­spite Med­i­caid ex­pan­sion

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Cal­i­for­nia is the lat­est state to re­port that emer­gency room us­age is up de­spite ex­pand­ing Med­i­caid el­i­gi­bil­ity.

ER vis­its by peo­ple on Medi-Cal, the state’s Med­i­caid pro­gram, rose 75% over five years from 800,000 in the first quar­ter of 2012 to 1.4 mil­lion in the last quar­ter of 2016, ac­cord­ing to state data.

Illi­nois, Mas­sachusetts and Ore­gon re­port sim­i­lar trends, which con­tra­dict what pol­icy ex­perts thought would hap­pen if peo­ple gained more in­sur­ance cov­er­age. They could also give Repub­li­can law­mak­ers the am­mu­ni­tion they need to dra­mat­i­cally overhaul Med­i­caid.

From 2013 to 2016, en­roll­ment in Medi-Cal grew by 57%; 5 mil­lion new mem­bers were added, bring­ing cur­rent en­roll­ment to 13.5 mil­lion. Medi-Cal now cov­ers more than one-third of all Cal­i­for­ni­ans, lead­ing some to claim that it’s the clos­est to universal cov­er­age of any state.

Cal­i­for­nia health of­fi­cials couldn’t ex­plain the rise, but providers say re­im­burse­ment rates have been too low to draw in enough physi­cians. There­fore, newly en­rolled Medi-Cal pa­tients con­tinue to seek care in hospi­tal ERs be­cause they can­not ac­cess pri­mary care in physi­cian of­fices and clin­ics.

Cal­i­for­nia ranks 47th in the na­tion for Med­i­caid pay­ment rates for providers, ac­cord­ing to the CMS.

Repub­li­cans have al­ready used re­ports of in­creased ER use in ex­pan­sion states and ris­ing spend­ing in the pro­gram as rea­sons to con­vert Med­i­caid into a per capita cap sys­tem. Med­i­caid spend­ing na­tion­ally rose 4.3% to $575.9 bil­lion in 2016 with the fed­eral share grow­ing 4.5% to $363.4 bil­lion, ac­cord­ing to the CMS.

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