Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

Medicaid patients use hospital emergency rooms more frequently than privately insured and uninsured patients but are not overusing or abusing ER services.
So says the Medicaid and CHIP Payment and Access Commission (MACPAC) in a recent report that contradicts the widely held belief that Medicaid patients abuse hospital ER services.
According to “Revisiting Emergency Department Use in Medicaid,” “Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured.”
In addition, MACPAC found, “High ED use also can be a sign of poor access to primary, specialty, dental, and outpatient mental health care in other settings.”  In 2012, for example, “…about one in four adult Medicaid enrollees who reported a recent visit to the ED went there because of difficulty accessing another provider, not because of a serious health problem.”
MACPAC also concluded that “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention…Non-urgent visits account for just 10 percent of all Medicaid-covered ED visits for non-elderly patients, a proportion comparable to that of privately insured patients.”
Pennsylvania’s safety-net hospitals serve far more Medicaid patients than the typical acute-care hospital and therefore face far greater challenges in meeting these patients’ needs.
Learn more about MACPAC’s findings in “Revisiting Emergency Department Use in Medicaid,” which can be found here.
 

2014-09-02T06:00:03+00:00September 2nd, 2014|Uncategorized|Comments Off on Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

MACPAC Recommends Steps to Ensure Continuity of Care

Citing income volatility among low-income Americans, the federal agency charged with analyzing Medicaid and the Children’s Health Insurance Program (CHIP) has recommended that Congress adopt measures to ensure that low-income Americans retain health insurance as their income fluctuates above and below the federal poverty level.
In its March report to Congress, MACPAC (the Medicaid and CHIP Payment and Access Commission) recommends that Congress empower states to extend coverage to eligible adults for an entire year to ensure that as those adults become eligible for Medicaid, lose Medicaid eligibility as their income rises, and then become eligible again because of unemployment or illness, they can maintain continuity of coverage and care.
MACPAC also recommends that Congress extend the current transitional medical assistance program so low-income parents who move into the workforce do not immediately lose their Medicaid coverage and that it eliminate the waiting period for CHIP eligibility and prohibit CHIP premiums for children from families whose income is less than 150 percent of the federal poverty level.
MACPAC is a non-partisan federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP and making recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting these programs.
For more information about MACPAC’s March 2014 report and recommendations, see this MACPAC news release or find the entire report here.

2014-03-21T06:00:49+00:00March 21st, 2014|Uncategorized|Comments Off on MACPAC Recommends Steps to Ensure Continuity of Care

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued its March 2013 report to Congress.
The agency, created to advise Congress on Medicaid and Children’s Health Insurance Program (CHIP) issues, offered two recommendations in its report.
First, it recommended that Congress authorize states to implement 12-month eligibility for adults enrolled in Medicaid and children enrolled in CHIP, in much the same manner as they now do for children enrolled in Medicaid.
And second, MACPAC urged Congress to fund permanently Transitional Medical Assistance (TMA), which enables families that become ineligible for Medicaid because they now earn more money than the program’s limit to retain their Medicaid eligibility for several additional months.
The MACPAC report also includes analyses of several issues involving services for dually eligible (Medicare and Medicaid) individuals.
Because Pennsylvania’s safety-net hospitals serve so many Medicaid, CHIP, and dually eligible patients, MACPAC’s recommendations and analyses can be especially important to them.
Find the MACPAC March 2013 report here.

2013-03-25T06:00:01+00:00March 25th, 2013|Uncategorized|Comments Off on MACPAC Reports to Congress
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