Emergency Room Visits Limited for Medicaid Patients

By: Troy Kinsey Email
By: Troy Kinsey Email

Tallahassee, Florida- July 31, 2012

The name says it all - it's supposed to be used only in the most dire circumstances, but that may not be happening.

Justin Senior heads up Florida's Medicaid program, which is now putting a hard cap on E.R. visits.

Beginning Wednesday, Medicaid patients can't go more than six times a year and expect to have their care paid-in-full.

"The hope would be that patients stop going from crisis to crisis and emergency room visit to emergency room visit, in some cases, as we analyze the data, going to the emergency room 50 to 150 times per year," said Senior.

Senior says only a few thousand Florida medicaid patients are racking up those kinds of numbers.

In voting against the caps, democrats in Florida's overwhelmingly republican legislature made it clear, they think the new policy is unfair.

"If you have private insurance, it's not capped at all. I don't understand this, guys!" said Democratic Representative Chuck Chesnut.

However, Governor Rick Scott says Medicaid is different - it's funded by taxpayers, and the caps on E.R. visits are only one part of his plan to bring the program down to size.

"Medicaid growth is at 180 percent. General growth is 30. You can't do that," said Governor Scott.

Still, as more Medicaid patients begin to hear about the changes, many of them may have the exact same reaction as all the lawmakers who voted 'no'.

Many consumer advocates are anything but happy about the new rule.

They predict Medicaid patients who have used up their E.R. visits but have a legitimate reason to go back will do exactly that.

Only then, Medicaid will no longer pick up what would have been a discounted bill, and with the patients too poor to afford it, taxpayers could have to shell out even more.

As part of the six-visit-per-year cap, medicaid patients also can't go to the emergency room twice in the same month and have their care covered.
It's important to point out the cap *does not* apply to children or pregnant women.

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