Two major concerns have come to light in regards to Medicaid reforms currently being discussed on the National level that could have a profound impact on emergency department care. Emergency Departments serve as the nation's health care safety net and play a critical role as first responders in homeland security, but this safety net is under considerable strain.
Co-pay for non-emergency care provided at emergency departments:
This idea was included in the National Governors Association's draft Medicaid reform proposal. A co-pay would be charged to Medicaid recipients who receive care in the emergency department that is determined to be non-emergent. While we recognize efforts to reduce unnecessary care, co-pays for emergency care cannot be implemented in practice because
Unintended consequences of other Medicaid reform efforts:
The Maryland Experience:
During the 2004 Legislative Session language was included in the FY2005 budget that a $10 co-pay be collected from "Medicaid recipients 21 years old or older who present to the hospital emergency room for non-emergency services". The co-pay amount was later reduced to $6 when the state found out that was the maximum that could be collected.
Ultimately the effort in Maryland to collect a co-pay failed. During the course of discussions it became readily apparent that the burden of administering and collecting the co-pay was going to far outweigh any potential benefits. The co-pay has since been taken off the table as the issues began to emerge such as: how will it be collected?, who will make the determination as to what an emergency is?, and the fact that requesting a co-pay prior to providing care violates federal EMTALA standards.
Information provided by the American College of Emergency Physicians (ACEP) and the Maryland Chapter, American College of Emergency Physicians (MD ACEP).