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New Medicaid Patients: Crush of ED Visits Subsides Over Time

LOS ANGELES – For emergency physicians wondering if the flood of newly insured Medicaid patients to ED will ever recede, here is an answer: If the other 26 states expanding Medicaid eligibility under the Affordable Care Act are anything like California, ED usage by those patients should decline sharply after the first year.

A new study by the UCLA Center for Health Policy Research suggests that the expansion of Medicaid to millions of uninsured residents will not continually drain state budgets because increases in ED and hospital inpatient usage are only temporary.

“We found that the surge doesn’t last long once people get coverage,” said lead author Nigel Lo, a research analyst at the UCLA Center for Health Policy Research. “Our findings suggest that early and significant investments in infrastructure and in improving the process of care delivery can effectively address the pent-up demand for health care services of previously uninsured people. Fears that these new enrollees will overuse health care services are just not true.”

For the study, researchers used two years of claims data from 182,000 low-income, formerly uninsured people enrolled in California’s state-run health insurance programs -- the Health Care Coverage Initiative, which ran from 2007 to 2010, and the Low Income Health Program, which ran from 2011 to 2013. At the beginning of this year, those enrollees were among the 1.5 million Californians who transitioned into Medi-Cal, California’s Medicaid program.

Analysis indicates that those who previously had the least access to medical care initially used hospital EDs at a high rate of 600 visits per 1,000 people. Usage significantly declined 29% in the first quarter, however, to 424 visits, followed by another 25% drop the following quarter. Between 2011 and 2013, the overall decline was 69.5% to 183 ED visits. At the same time, hospital admissions saw a steep 78.5% decline from 192 to 42 per 1000.

“California’s success should set an example for states that are on the fence about expanding Medicaid,” suggested co-author Gerald Kominski, PhD, professor of health policy and management and director of the Center for Health Policy Research. “It’s an investment: Build more infrastructure and care delivery early on, and you can manage chronic care, address unmet health care needs, and keep cost increases to a manageable level.”

While the Affordable Care Act extends Medicaid eligibility in 27 states, many other states refused coverage because of concerns that state budgets would be depleted by the demands of the previously uninsured, especially when federal subsidies stop covering the full costs in 2017.

The UCLA study, funded by the California Department of Health Care Services and the Blue Shield of California Foundation, cites previously published research finding that ED visits in Oregon increased by 40% during the year after the state expanded Medicaid eligibility, adding that their longer term examination of data shows such usage spikes are temporary.