The recent Medicaid expansions have been controversial, especially where they concern emergency department use. But what is true, and what is hype? The following are five commonly held beliefs about Medicaid patients and ED use, answered by CMS and the Children's Health Insurance Program Payment and Advisory Commission:
Myth: Much of Medicaid patients' ED use is unnecessary.
Reality: False. Ninety percent of visits by nonelderly patients are for urgent symptoms or serious medical conditions that require immediate attention.
Myth: ED use among Medicaid patients is increasing.
Reality: Unclear. The data is conflicting. Patient-reported visits are no higher, though hospital administrative data shows adult Medicaid visits are increasing.
Myth: Medicaid patients use the ED because they have difficulty scheduling with their regular provider.
Reality: True. This reason accounts for nearly one-third of all ED visits by Medicaid patients.
Myth: Better primary care access would lower Medicaid patients' ED usage.
Reality: True. While it may not impact super-utilization, individuals that use the ED without also using other specialty care services on a regular basis could benefit from better primary care access.
Myth: ED use will balloon with the 2014 Medicaid expansion.
Reality: Unclear. While there are several case studies, including in Oregon, Massachusetts and California, how Medicaid expansion affects ED use will vary state-by-state, according to the status of that state's healthcare provision.