Medicaid to stop covering visits to ER later deemed 'unnecessary'
Medicaid soon won’t cover emergency-room treatment that state officials decide afterward was “not medically necessary.”

A state Health Care Authority rule putting a three-visit limit on unnecessary ER use by poor patients was blocked in court on procedural grounds. The agency has replaced it with a new policy taking effect April 1 that would reduce the number of conditions deemed non-emergencies but would forbid even a single unnecessary visit.

The doctors and hospitals who sued over the old rule blasted the new plan Tuesday, saying it would leave it up to a “faceless bureaucrat” to decide what’s an emergency. They weren’t ready to say they’ll go to court again over it.

Medical providers will foot the bill if they treat patients and the state doesn’t pay. They can’t bill the patients, as was possible under the old rule, the Health Care Authority says.

“The client is not at risk anymore for the ER bills,” said Dr. Jeffery Thompson, chief of the state’s Medicaid program. “This is invisible to the client. The client’s going to get treatment regardless.”

The move is part of an ongoing attempt by state government to crack down on excessive ER use. Other kinds of treatment have such limits, Thompson says.

He points to patients seeking ER treatment for diaper rash and other ailments better treated by a primary-care doctor, and to hospital frequent fliers who show up twice a day, as he said one patient with obsessive-compulsive disorder did recently. The hope is to divert such patients to other providers.

Lawmakers cut $33 million out of the state budget by demanding tighter ER rules for Medicaid, but now the full cut is unlikely to be achieved by the end of the budget period on June 30, 2013. The HCA expects to be about million of dollars short of its savings target.

A judge ruled last year that the HCA hadn’t followed the correct rule-making process in establishing a three-visit limit on unnecessary ER use. But the federal Centers for Medicare and Medicaid Services later said the agency was within its authority to deny coverage, Thompson said. The state proceeded with a flat ban after the feds saw the three-visit limit as “problematic.”

If it is not an emergency, they don't need to be there and we should not be paying. The emergency room should be just that, the emergency room. It should be for trauma and life threatening illness. Instead it is clogged up with welfare recipients who have a common cold, the flu or a stomach ache because they ate too many ding dongs. They know they will not be turned away and they know someone else is getting stuck with the bill. I probably sound callous, I've seen it too many times. The parasites are killing the host.

You really don't get it do you? They have no other medical services available to them. Hence the emergency room is where they go. How if there were urgent care facilities, that would work, but again, the government is punishing the victims rather than addressing the real problem, lack of available medical care for the lower income members of our society. Oh and I have worked in EMS and the wife still does. I have seen why and you obviously don't really understand the problem.

Hey, I'm with you on mooches. My point is that health care in Canada is still free for all citizens, but costs a fraction per person as compared to what the health care system costs tax payers down here. If you add up costs for Medicare, Medicaid, state, federal, and private insurance, things look pretty bad from a cost / benefit comparison, no matter where the money comes from. Nothing is for free, but a lot of money flows from tax payers to government, and gets pissed away with no benefit to the population at large. Cost per person is the big difference between us and them.