Report: Medi-Cal Beneficiaries Have Driven Surge in ED Visits

Medi-Cal patients largely have driven an increase in emergency department visits in California, which could have implications for when the program is expanded under the Affordable Care Act in 2014, according to a research letter published in the Journal of the American Medical Association, MedPage Today's "The Gupta Guide" reports.

Medi-Cal is California's Medicaid program (Petrochko, "The Gupta Guide," MedPage Today, 9/17).

Background on Medi-Cal Expansion

Under the ACA, a state expansion of Medi-Cal will allow individuals with incomes up to 138% of the federal poverty level, or $15,415 annually, to gain coverage.

The federal government will fund the expansion for the first few years, according to the ACA (California Healthline, 9/3).

Details of Research Letter

UC-San Francisco researchers examined ED data among patients ages 19 to 64 from 2005 to 2010.

They used information released by the state Office of Statewide Health Planning and Development.

Findings

The research letter found that California ED visits increased by 13.2% from 2005 to 2010, from 5.4 million to 6.1 million annually (Medical News Today, 9/17).

During that time, there was a:

• 35% increase in ED visits among Medi-Cal beneficiaries;
• 25.4% increase in ED visits among uninsured individuals; and
• 1.2% increase in ED visits among privately insured individuals.

In addition, the report found that nearly 55 out of every 1,000 Medi-Cal beneficiaries sought care for ambulatory care-sensitive conditions, compared with about 11 per every 1,000 privately insured individuals and about 17 per every 1,000 uninsured individuals ("The Gupta Guide," MedPage Today, 9/17).

The authors wrote, "Increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care" (Medical News Today, 9/17).

Reaction

David Howard of Emory University's Rollins School of Public Health said, "Medicaid beneficiaries may lack access to primary care services and, to the extent that access to primary care deteriorated over the decade, Medicaid beneficiaries may have decided to use more emergency room services to replace the primary care shortfall."

However, he noted that the researchers did not examine "rates of use across all types of services," which he said would have better determined whether the trends are "due to something that's really specific to emergency rooms or are there trends across the board that are driving up use."

Meanwhile, James McCarthy of the University of Texas Health Science Center said the upcoming Medicaid expansion "will certainly increase [ED visits] as Medicaid beneficiaries will have the most difficulty getting into primary care clinics" ("The Gupta Guide," MedPage Today, 9/17).