![]() ![]() Instead of pushing this substantial change to privatized managed care, OHCA could instead adopt practices that increase access to primary care outside of normal work hours, such as increasing funding for community health centers. Research suggests that managed care doesn’t impact ER utilization. No matter what, it’s unlikely that the state’s push to privatize the Medicaid program will help address ER usage. Either way, any increase will likely be temporary, with ER usage declining after a few months, possibly even to levels lower than the pre-expansion period. Another study of 14 states that expanded Medicaid found an increase of only 2.5 visits per 1,000 people. After Medicaid expansion, Kentucky saw a one percent increase in ER visits, and Maryland did not see any increase at all. Any increase in ER visits will likely be small, based on evidence from other states. ER usage may increase slightly following the implementation of Medicaid expansion but will likely decline over time as individuals receive more preventative care. Oklahoma’s decision to expand Medicaid this year may change the situation, although not in any meaningful magnitude. Medicaid expansion could temporarily increase ER usage, but managed care won’t solve that problem (If we also include additional ancillary services, the total cost was $177 million, or 3.2 percent of total expenditures.) If Oklahoma policymakers are looking for ways to decrease health care spending, demonizing a group that accounts for a tiny fraction of total spending would be an ineffective place to start. In fiscal year 2019, total emergency department costs for SoonerCare members were $139 million, which represented less than 3 percent of the total SoonerCare expenditures of $5.6 billion. It is also not apparent that ER visits are a major expense in the Medicaid program. ER usage among SoonerCare members has steadily declined in recent years, making it unlikely that this will cause health care costs to balloon in the near future. All Oklahomans (regardless of health care coverage) had 492 ER visits per 1,000 people in 2019, and that number was 533 visits per 1,000 Medicaid enrollees. Even when accepting the premise that some Medicaid patients use the emergency room at a higher rate, it is clear that the hypothetical misusers make up a tiny proportion of all SoonerCare members.Īdditionally, although differences in demographic make-up and data sources make direct comparison difficult, ER utilization for Medicaid patients appears to be stable - with annual visits ranging from 0.52 to 0.62 per member since 2007 - and comparable to the overall population. ![]() Only 11,073 individuals, or 1.1 percent of those insured by Medicaid, had six or more ER visits. Another 22 percent visited the ER once or twice. In the fiscal year ending in 2019, nearly three in four Medicaid patients (73 percent) made no emergency room visits at all. In fact, ER utilization rates have significantly decreased in recent years. SoonerCare patients aren’t overusing the emergency roomĮR usage by SoonerCare members is nowhere near as pervasive or as serious a problem as many assume, according to data from the Oklahoma Health Care Authority (OHCA). Legislators concerned about rising health care costs should worry less about the health care practices of individual SoonerCare members and more about how we can most effectively provide health care for all Oklahomans through the SoonerCare program. In reality, Oklahoma’s SoonerCare enrollees use the emergency room at rates comparable to the general population, and emergency services represent a small fraction of total SoonerCare expenditures. However, there is little evidence to support this claim. Īs part of a larger pattern of demonizing the social safety net, critics of the Medicaid program frequently claim that patients overuse emergency rooms for non-emergency care and that the state must address this problem to contain Medicaid spending. Note: This post has been updated to correct the number of ER visits by Medicaid enrollees reported in 2019 and to clarify that the declining trend of ER utilization is unlikely to cause health care costs to increase in the near future. Co-authored by Josie Phillips, policy intern.
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