Medi-Cal Enrollees Driving ER Usage

Californians enrolled in Medi-Cal are visiting emergency rooms at a much higher rate than individuals with other forms of insurance, raising questions about how hospital utilization patterns may change as the Affordable Care Act rolls out next year.

Researchers at UC San Francisco analyzed emergency room visit patterns in California between 2005 and 2010. They increased 13.2% during that period, from 5.4 million to 6.1 million a year.

There were nominal rises among those who had healthcare coverage and those without insurance. 

Among those with insurance, it rose from 158 to 164 visits per 1,000 persons. Among the uninsured, the rate rose from 242 to 259 visits per 1,000.

However, those visiting the ER enrolled in Medi-Cal saw a much more dramatic rise, from 572 to 651 visits per 1,000, an increase of about 14%. Policy experts believe this may be connected to poor primary and preventative care access for Medi-Cal enrollees.

Under the ACA, income eligibility requirements for Medi-Cal enrollment are being relaxed, starting with a pilot project that was launched last year. Over enrollment in the program is expected to rise by between 1.2 million and 1.6 million by the end of the decade, according to research released last year by UC Berkeley. 

Enrollment in Medi-Cal has risen by 35% in recent years, fueled by millions of Californians who lost their insurance coverage or saw their income drop during the Great Recession.

“All the findings suggest that emergency department use may actually increase with healthcare reform, instead of decline, if most of the uninsured patients become eligible and enroll in Medicaid,” said Renee Hsia, M.D., the study's lead author. “These results should not discourage policymakers from pursuing health care reform. Rather we hope our study will shed some light on issues that need to be addressed as we continue to expand insurance coverage to millions of uninsured patients.”

The analysis was published in the most recent edition of the Journal of the American Medical Association.