Medicaid Changes in Kentucky

From the Louisville Courier-Journal:

Medicaid patients who use emergency rooms for non-emergencies may have to pay the bill themselves, Kentucky officials said yesterday.

The state is considering such a measure as a way of controlling the cost of non-emergency visits, estimated at as much as $50 million a year, officials said.


The proposal also comes after state officials said they determined that a small number of Medicaid patients are the worst abusers of emergency rooms and may be using them to feed prescription-pill addictions.

State officials only recently learned that they can refuse payment for non-emergency visits to emergency rooms, said Mark D. Birdwhistell, state undersecretary for health.

If Medicaid won't pay the bill, patients would have to do so themselves -- or the hospital would take the loss.

Asked about the likelihood of imposing such an option for Medicaid, Birdwhistell said in an interview, "Stay tuned.''

Medicaid officials said last week that they expect to announce cost-saving measures in the next few weeks, particularly addressing emergency-room and prescription-drug costs.

Kentucky's Medicaid plan for the poor and disabled is struggling to reduce a projected $425 million budget shortfall this year. Officials hope to avoid cuts like those during the administration of Gov. Paul Patton that forced thousands of people to lose nursing home or other health services.

Birdwhistell and Medicaid Commissioner Shannon Turner told lawmakers yesterday that recent data show 49 Medicaid members are the heaviest users of costly emergency rooms.

They often walk away with prescription painkillers.

Those 49 visited emergency rooms at least 50 times each in the past year, most frequently citing headaches or back pain.

"Is this a drug-seeking population or a population in chronic pain?" Turner asked while appearing before the joint House-Senate Health and Welfare Committee meeting in Louisville.

The state recently added a $3 co-pay for emergency room visits, but people can't be turned away if they don't have it.

Dr. Rick Voakes, a Bowling Green pediatrician who treats many Medicaid patients, said he thinks refusing to pay for non-emergency visits is a good idea.

"I think that's very reasonable," said Voakes, who was not at the hearing.

He said he's frustrated to learn his patients often use the emergency room, potentially costing hundreds of dollars instead of visiting his office, which costs Medicaid about $27.

"They just go straight to the emergency room because they know they can go any time they want to for free," he said.