A controversial Medicaid policy stopped by the governorChris Gregoire, Washington governor has stopped the implementation of Medicaid policy, which would have seen emergency department services denied payment where a patient is determined ultimately to have a condition that is non-urgent. Washington State Health Care Authority was scheduled to meet on April 1 where they were to deliberate on emergency department coverage for visits based on the final diagnosis instead of symptoms that made the patient check in at the ED in the first place. For instance, take a case where the patient complains of chest pain and is discharged after being diagnosed with esophageal reflux infection.

Non urgent medical conditions

There has been over 500 diagnoses developed by the healthcare authority for conditions deemed to be ‘non- urgent’ for the Medicaid emergency patients. Some of these conditions include urinary tract infection, sprains and bronchitis which the hospitals won’t be getting a reimbursement from Medicaid. The American College of Emergency Physicians strongly opposes these policies. According to the group, states experiencing cash trap issues are considering implementing the policies as a way of minimizing the heavy spending made on their Medicaid programs. Once the patient just walks into the hospital emergency department, the physician has no idea of the diagnosis until he or she examines the person, say David Seaberg, president, MD of ACEP through a press release sent in February. According to Greigore’s spokesman, the governor found it necessary to suspend the policy implementation at the last minutes.

The Medicaid policy had some flaws

According to a report by Seattle Times, Greigore’s director of counter budget noted increased support for various legislative alternatives to helping Medicaid save money. ACEP was thrilled with the news as the seemingly ‘medically important’ policy wasn’t going to be effected immediately. Seaberg expressed his gratitude to the governor for recognizing the fact that the plan had some flaws that needed to be addressed before being implemented. The governor not only stood up for the Medicaid patients but rather for all the patients. The proposed non- emergent diagnoses listed not only put the patients in grave danger also targets the poor unfairly and those in dire need of medical care. Fortunately, no one is going to experience the biting effects of the policy unless it is amended and found fit for approval.

According to ACEP, they support a ‘prudent layperson standard’ implemented nationally where health plans are designed to cover emergency visits based on the belief of the average person that he could be suffering from a medical emergency. A state court in Washington had earlier in November overturned a plan which aimed at denying Medicaid payment where a Medicaid patient had made at least three visits to the emergency departments. Now, everyone can sigh with relief thanks to the governor who recognized the need to amend the proposed plan to make it more meaningful and useful.