The Utah Department of Health is seeking public comments BY JULY 20TH on their proposed changes to the Medicaid waiver with the intent to reduce overall costs. These changes include capping enrollment at 25,000 people, imposing a 60 month lifetime cap for recipients and work requirements with no way to assess a person’s ability to work. Cutting Medicaid services like this does not cut costs — it unfairly transfers those costs other places, such as to hospitals.
Considering the state is already in the midst of several public health related crises, this is not the best time to make changes that will reduce access to care. These crises include:
- Opioid epidemic
- Exploding homeless population
- Low wages during a critical housing shortage, resulting in high rents and few expendable dollars for rising healthcare costs
Additionally, the state is seeking to reduce costs by mandating a copay or penalty fee for Emergency Department (ED) use for non-emergency care. While it may seem economically sound to implement a fee in order to reduce unnecessary utilization of emergency room care, the research from 9 states that have experimented with similar fees indicates that they make no difference on emergency department use and may discourage people with potentially time-sensitive or life-threatening conditions from using the ER when they truly need it.
However, other states have used different methods to minimize costs and reduce unnecessary ED use with good success. For example, Washington State developed a program to identify frequent ED users and work with them to schedule appointments with primary care providers within 96 hours of an ED visit. The state also established a call-in line staffed by nurses to triage care and initially assess whether the problem warrants an ED visit. As a result, the state has seen a 10 percent reduction in non-emergency use and a $35 million reduction in costs to the Medicaid program.
CALL TO ACTION
- Write a comment to the Utah Department of Health before July 20th using their online comment form to oppose enrollment caps, lifetime caps, work requirements and co-pays for non-emergent Emergency Room use. Although lowering the cost of Medicaid is essential for expanding coverage to those who need it, these proposed measures unnecessarily reduce coverage without reducing costs. There are better ways to reduce costs for Medicaid. Be sure to include any personal stories about the need for Medicaid and/or any expertise in good health policy. Or simply encourage UDOH to utilize existing data to create their cost savings plan.
More talking points
The Pew Charitable Trusts discusses programs and ideas that reduce costs without reducing Medicaid programs in their article, “States Strive to Keep Medicaid Patients Out of the Emergency Department“. Some salient points:
- It is important to put Emergency Department costs in perspective: ED use comprises only 4% of Medicaid spending.
- Medicaid patients use the emergency room more than private insurance patients because Medicaid patients are generally unhealthier, have less access to primary care, have jobs with hours that don’t allow for office hour visits or don’t have transportation to get to doctor’s offices. ED copays do nothing to combat these issues.
- One study shows that of the 6.3 percent of emergency room visits in 2013 later determined to have been unnecessary, 89 percent of them were cases in which the patient had exactly the same complaint—chest pains, for example—as somebody who truly needed to be in the ED.
- Most Medicaid patients who go to the ED belong there, with only 9.8% of Medicaid patient visits to the ED later determined to be non-urgent. This number does not take into account the symptoms a patient experiences that led them to visit the ED, including symptoms that can mimic life-threatening conditions.
- Cutting Medicaid services does not cut costs — it unfairly transfers those costs