Recently, the state of Washington decided to place a limit on the number of visits to the emergency room that would be covered by patients who use Medicaid. The American College of Emergency Physicians is now suing the state of Washington over this decision.
The state of Washington is trying to find a way to handle its financial problems for the 2011 – 2013 budget. The way the state wants to do this is by limiting the amount of coverage that people who use Medicaid will receive for non-emergency visits to a hospital emergency room. This change has already taken effect.
From now on, Medicaid patients will be allowed to visit an emergency room up to three times in a given year for a non-emergency medical situation. Medicaid will cover the cost of these three visits. However, if that person ends up visiting the emergency room again, for non-emergency reasons, within that same year, then Medicaid will not cover it. Instead, the person “may be asked to pay” for the extra visits out of their own pocket.
There doesn’t seem to be a limit placed upon Medicaid coverage for visiting an emergency room for what turns out to be a real medical emergency. The state of Washington is trying to prevent people who do not have health insurance from using emergency rooms as their primary care physician. The state also wants to discourage people who have gotten into the habit of visiting the emergency room hundreds of times in a given year for things that are not an emergency.
In order to clarify the distinction between a medical emergency, and a non-emergency medical situation, the state of Washington has created a list of 700 symptoms that it considers to be a non-emergency situation. The list includes things like: difficulty breathing, dizziness, early-pregnancy hemorrhage, gall stones, abdominal pains, and chest pains that are not related to a heart attack.
Doctors feel that this list of non-emergency symptoms is a bad idea. They do not want people to sit at home and attempt self-diagnosis while they are experiencing what could be a serious health condition. They also feel that the Medicaid coverage limitation sends out the message that people should stay away from the emergency rooms. This is the wrong message to be sending.
The American College of Emergency Physicians (ACEP) is suing the state of Washington in an attempt of overturn the decision that limits Medicaid patients to three non-emergency visits to an emergency room in a given year.
The Washington State Hospital Association (WSHA), the Washington State Medical Association (WSMA) and the Washington Chapter of Academy of Emergency Physicians (WCAEP) have each released statements saying that these groups object to the change in Medicare coverage limitations.
Right now, a person who is using Medicaid will be covered for three non-emergency visits to an emergency room. If that person comes to an emergency room for non-emergency symptoms more than three times, the person will be treated by the doctors and nurses who work in the ER. However, the state of Washington will no longer pay the hospital for the health care that the person received.
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