Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

Abstract

Key Points Question Is Medicaid eligibility expansion associated with changes in emergency department (ED) visits based on the medical urgency of the conditions? Findings In this cross-sectional study of 80.6 million ED visits across 4 US states, ED visits per 1000 population decreased for states that expanded Medicaid compared with states that did not. This decrease was associated with decreases in ED visits for less-emergent or nonemergent conditions. Meaning The findings of this study suggest that expanding Medicaid might reduce ED visits for conditions that could be treated in outpatient settings.

Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

“…Although Giannouchos et al found encouraging patterns of ED use, other studies have found the opposite. In particular, a 2019 study by Garthwaite et al, which also used Healthcare Cost and Utilization Project data, but included 20 states and all ED visits (both outpatient ED visits as well as those leading to inpatient admission), found that ED use for deferrable conditions increased in expansion states relative to nonexpansion states, whereas those for nondeferrable conditions did not.…”

“…The investigators found that Medicaid expansion was associated with a significant reduction in overall ED use by 4.7 visits per 1000 population. 3 Furthermore, this reduction was associated largely with changes in the subgroups of ED visits that are potentially avoidable, with greater decreases noted for the least severe conditions that are likely to be most avoidable and smaller decreases for higher severity conditions. Visits classified as nonemergent decreased by 1.5 visits per 1000 population, those classified as primary care treatable declined by 1.1 visits per 1000 population, and those classified as emergent, but potentially preventable declined by 0.3 visits per 1000 population (all statistically significant declines).…”

“…In this study, the authors examined 80.6 million outpatient ED visits from the Healthcare Cost and Utilization Project State Emergency Department Databases and a difference-in-differences design to evaluate changes in the rate of outpatient ED use in 2 Medicaid expansion states (New York and Massachusetts) vs 2 nonexpansion states (Georgia and Florida) from 2011 to 2017. 3 Emergency department visits were stratified by severity using the New York University algorithm, which classifies visits based on their likelihood that the primary diagnosis will fall into 1 of 4 subgroups: (1) emergent, not preventable, (2) emergent but potentially preventable, (3) emergent but primary care treatable, and (4) nonemergent. Emergency department visits related to injuries and behavioral health conditions are also classified (or classified separately).…”

“…However, answering this question largely hinges on the extent to which Medicaid expansion improves the efficiency of health care use and spending. Giannouchos and colleagues examine whether Medicaid expansion was associated with improvements in the use of what is often one of the most expensive health care settings: the emergency department (ED). Their simple yet revealing study further contributes to the literature by noting that Medicaid expansion is a good value for states and is likely to reap long-term benefits in the form of better population health and lower health care spending.…”

“…The investigators found that Medicaid expansion was associated with a significant reduction in overall ED use by 4.7 visits per 1000 population …”