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ER use by Medicaid patients cost OK taxpayers $170M

By   /   April 4, 2013  /   No Comments

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At the Oklahoma State Capitol, concerns about Medicaid costs are rising. A new analysis finds emergency room visits covered by Medicaid cost taxpayers nearly $170 million in fiscal fear 2012.

By Patrick B. McGuigan | Oklahoma Watchdog

OKLAHOMA CITY — Just three years ago, health care costs became the top budget cost driver in the state budget, surpassing the traditional top item, K-12 public education.

Medicaid expenses will continue to rise, with or without the expansion envisioned in the Affordable Care Act.

Overall, taxpayer costs for Medicaid rose 190 percent from 2000 to 2012. Virtually every aspect of Medicaid coverage has helped push overall costs higher.

As one example, with more than one-fourth of state residents now covered by Medicaid, emergency room costs for Oklahoma’s Medicaid recipients reached nearly $170 million in fiscal year 2012, according to information obtained by Oklahoma Watchdog.

The Oklahoma Health Care Authority says there were 1,007,030 Oklahomans enrolled in Medicaid programs in fiscal year 2012 — 26.57 percent of the state population.

Of those, 250,030 utilized emergency room services. The total number of ER visits reimbursed by Medicaid that year was 528,264, yielding an average of just over two visits for each ER “utilizing member” in the system.

The average includes many who visited emergency rooms much more often.

In FY 2012, the total cost for ER services provided to Oklahoma Medicaid enrollees was $169,642,272, which included costs for physicians, pharmacy, lab, radiology, ambulance and other items.

The average cost per ER visit for Medicaid patients in FY 2012 was $321. Emergency services are exempt from co-pays in Medicaid. The state does not limit the number of emergency room visits for Medicaid enrollees.

The Health Care Authority does not have an emergency room diversion program.

However, with a program called the High ER utilization project, the authority sends letters to Medicaid members with “high ER utilization” in any one calendar quarter. Informational letters go to those who make two or three visits in a quarter.

Those with four to 15 visits in a quarter are asked to call the agency, and are directed to someone who will talk to them about ER use.

Medicaid “members” with 16 or more visits are contacted through letters, phone calls and in some cases face-to-face visits, to discuss changes in ER use by the member. After all avenues have been explored, if high usage continues, a case can be referred to the agency’s legal division to begin a process that might lead to sanctions in the form of withdrawn benefits.

Contact Patrick B. McGuigan at Patrick@capitolbeatok.com and follow us on Twitter: @capitolbeatok.

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Patrick B. McGuigan is bureau chief for the Oklahoma City Bureau of Watchdog.org, and works from the press room at the state Capitol. He is also the editor of CapitolBeatOK, and Associate Publisher of The City Sentinel newspaper. In 2013, The Washington Post blog “The Fix” designated Pat one of the best reporters in Oklahoma. In addition to the Oklahoma Society of Professional Journalists, where he serves as state secretary-treasurer, Pat is a member of the National Press Club and the Tulsa Press Club.

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