IN BRIEF: Emergency Room usage by Oklahoma Medicaid recipients
Published: April 4th, 2013
OKLAHOMA CITY – Just three years ago, health care costs became the number one budget cost-driver in the state budget, surpassing the traditional top item, K-12 public education.
Medicaid expenses will continue to rise, with or without the expansion envisioned in the Affordable Care Act.
Overall, taxpayer costs for Medicaid rose 190 percent from 2000 to 2012.
Virtually every aspect of Medicaid coverage has helped push overall costs higher.
As one example, with more than one-fourth of state residents now covered by Medicaid, emergency room costs for Oklahoma’s Medicaid recipients reached nearly $170 million in Fiscal-Year 2012, according to information obtained by CapitolBeatOK.
The Oklahoma Health Care Authority says there were 1,007,030 Oklahomans enrolled in Medicaid programs in FY 2012 — 26.57 percent of the state population.
Of those, 250,030 utilized Emergency Room services, CapitolBeatOK has found. The total number of ER visits reimbursed by Medicaid that year was 528,264, yielding an average of just over two visits for each ER “utilizing member” in the system.
The average includes many who visited emergency rooms much more often.
In FY 2012, the total cost for ER services provided to Oklahoma Medicaid enrollees was $169,642,272, which included costs for physicians, pharmacy, lab, radiology, ambulance and other items.
The average cost per ER visit for Medicaid patients in FY 2012 was $321. Emergency services are exempt from co-pays in Medicaid. The state does not limit the number of emergency room visits for Medicaid enrollees.
The Health Care Authority does not have an emergency room diversion program.
However, with a program called the High ER utilization project, the authority sends letters to Medicaid members with “high ER utilization” in any one quarter (three months). Informational letters go to those who make two or three visits in a quarter.
Those with four to 15 visits in a quarter are asked to call the agency, and are directed to someone who will talk to them about ER utilization.
Medicaid “members” with 16 or more visits are contacted through letters, phone calls and in some cases face-to-face visits, to discuss changes in ER utilization by the member. After all avenues have been explored, if high usage continues, a case can be referred to the agency’s legal division to begin a process that might lead to sanctions in the form of withdrawn benefits.
You may contact Patrick B. McGuigan, Oklahoma City bureau chief for the Watchdog.org network, at Patrick@capitolbeatok.com and follow us on Twitter: @capitolbeatok.