Insight & Analysis / Medicaid and Emergency Department Use
Coloradans covered by Medicaid are more likely to go to the emergency department (ED) than those with other types of insurance, though the rate for Medicaid enrollees has declined in recent years.
About 36 percent of Medicaid enrollees used the ED at least once in the 12 months before the 2013 Colorado Health Access Survey (CHAS) was taken. That compares to 20 percent for all Coloradans and 17 percent for those with commercial insurance. (See graph below)
Even so, ED use among Medicaid enrollees dropped about nine percentage points between 2009 and 2013, falling from 44.8 percent to 36.4 percent.
The Colorado Health Institute’s Safety Net Advisory Committee (SNAC) learning lab recently examined ED use in Colorado. Participants hypothesized that the decline in use among Medicaid enrollees may be related, at least partially, to the opening of urgent care facilities. These facilities provide an alternative for patients who might otherwise go to EDs.
Meanwhile, based on the research showing a higher rate of ED use among Medicaid enrollees, the Colorado Health Institute anticipates that ED use will rise in Colorado in the wake of this year’s Medicaid expansion. Colorado opted to expand Medicaid eligibility up to 138 percent of the federal poverty level beginning in January. So far, more than 178,000 people have signed up for Medicaid.
A recent study in Oregon found that newly-enrolled Medicaid beneficiaries used the ED at a higher rate than a control group of people without Medicaid coverage. The study was launched following a limited Medicaid expansion in 2008. Those who were chosen for Medicaid visited the ED an average of 1.43 times over an 18-month period, while those who did not receive Medicaid coverage visited it 1.02 times, on average.
How to slow inappropriate use of the ED has been center stage in discussions about how to decrease health care costs. The Colorado Health Institute will be monitoring whether Medicaid expansion or the Affordable Care Act affect ED use or health care costs in Colorado.