Speak with an Agent1-800-920-4994

A HealthNetwork Partner

Obama Rules, Budget Woes Spur Medicaid Benefit Cuts

A Picture of Abby Coleman Abby Coleman



Critics who worried ObamaCare would lead to rationing may be seeing their fears realized sooner than they expected. Recently, Washington state changed its Medicaid program so that recipients may only go to the emergency room three times per year for “nonemergency” conditions.

The initiative is expected to save about $72 million over two years. Yet the conditions that are considered nonemergent under the program include chest pains, asthma and abdominal pains.

“Many of the people who exceed the three-visit limit are people with chronic conditions or generalized complaints who are going much more often to the emergency room and are clearly aware that it is not an emergency,” said Jim Stevenson, communications director for the Health Care Authority, which oversees Medicaid in Washington. “The hope is to move them into primary care.”

State Medicaid recipients can still go to the ER after three visits, but could be charged if it’s nonemergent.

Dr. Nathan Schlicher, spokesman for the American College of Emergency Physicians, worries that “patients who have hit the three-visit limit could be discouraged from going to the emergency room when they have something serious. We’re talking about some pretty serious medical conditions.”

ACEP has filed a lawsuit to block the three-visit limit.

But the simple fact is that Medicaid is an ever-growing share of state budgets. With budgets strained, governments have sought ways to reduce expenses.

Earlier this year, Washington reduced the rates that Medicaid pays to providers. Thirteen other states have also cut rates: Arizona, Colorado, Connecticut, Florida, Nebraska, New Hampshire, New York, North Carolina, Oregon, South Carolina, South Dakota, Texas and Virginia.

California cut rates 10%, but that’s been suspended pending a legal challenge. The Golden State also limited Medicaid recipients to seven doctors visits per year.

Late last year Arizona stopped letting Medicaid pay for certain transplant surgeries.

Expect more rationing to sicker patients because doing so poses few risks to politicians, one analyst suggests.

“When health care systems are politically controlled, politicians direct resources away from the seriously ill who need expensive advanced medical care, to the healthy voter,” said Linda Gorman, a senior fellow at the conservative Independence Institute. “Relatively few voters need advanced care, so catering to the healthy makes political sense.”

Since 2009, states have faced new rules that prevent them from reducing their Medicaid eligibility standards. The 2009 stimulus provided short-term cash to shore up Medicaid, but states had to agree to never cut their eligibility levels or risk losing the federal funding. And when ObamaCare fully kicks in, states will have to expand Medicaid to 133% of the federal poverty level.

Also, the congressional deficit “supercommittee” may be looking at ways to cut Medicaid.

So states can’t lower eligibility rates and many have cut already-low Medicaid reimbursements. As a result, they increasingly are turning to slashing benefits.

Washington state says it doesn’t want Medicaid patients to feel they can’t get emergency care.

“If Medicaid clients feel they are having an emergency, they should go to the ER,” said Stevenson, adding, “If a patient has a nonemergent condition but the ER physician feels there was a strong reason for it to be an exception to the rule, there is a process in place so it can be challenged.”

Schlicher replied, “There is very limited criterion under which physicians can do that. There is no check box that says, ‘I think this was this was a reasonable emergency.'”

Health Network Group
301 Clematis Street
Suite 3000
West Palm Beach, FL 33401
This website is privately owned and all information and advertisements are independent and are not associated with any state exchange or the federal marketplace. Additionally, this website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid or the Department of Health and Human Services.