ER docs Medicaid complaint: Some patients denied coverage if diagnosis doesn't merit their care

Mar 2 2012

Some states are not considering the symptoms that brought the patients to the hospital, the doctors charge. In other Medicaid news, Texas is looking at several options for Medicaid reform, Pennsylvania looks at human service program cuts, Wisconsin Democrats seek to stop reductions there and Minnesota officials respond to criticism from Sen. Charles Grassley.

MedPage Today: Coverage Denials Draw Ire of Emergency Docs
Medicaid officials in some states are denying coverage for emergency department visits based on final diagnosis codes rather than the symptoms that brought the patient in, according to the American College of Emergency Physicians (ACEP). ACEP said cash-strapped Medicaid officials are increasingly implementing plans to deny payment for emergency department services if the patient is ultimately determined to have a non-urgent condition (Walker, 2/29).

Earlier, related KHN story: Hospitals Demand Payment Upfront From ER Patients With Routine Problems (Galewitz, 2/20).

The Texas Tribune: Texas Lawmakers Working To Reform Medicaid
Regardless of how the Supreme Court rules on President Obama's health care reforms next month, the state of Texas is pursuing plans to completely revamp the way it runs Medicaid. Of course, it must first get the federal government's approval. ... In 2014, the Affordable Care Act will require all Texans to sign up for health benefits (though the state estimates about 9 percent will still fall through the cracks and remain uninsured). Medicaid is expected to increase from 3.5 million to 5.7 million beneficiaries. To deal with the increase in demand, the state is pursuing changes on two fronts (Tan, 2/29). 

The Philadelphia Inquirer:  Pa. Welfare Secretary Defends Proposed Funding Cuts, Program Rollbacks
In his budget blueprint for the fiscal year beginning in July, (Gov. Tom) Corbett is proposing roughly $620 million in cuts and savings to human services programs. They include eliminating cash payments to poor adults, cutting aid by 20 percent for county-run social service programs, and reducing reimbursements to hospitals and nursing homes serving the poor. Those changes come on top of reports that 89,000 children have been dropped from the state's Medicaid rolls since August, and the administration's plan to impose an assets test, come May, on people seeking to receive food stamps (Couloumbis, 2/29).

Wisconsin Public Radio: Dem Bill To Stop Proposed Cuts To BadgerCare
Two Democrats have a bill that would stop proposed cuts to BadgerCare. Health care changes passed in Act 10 last year didn't immediately get the overwhelming attention that other changes in the budget repair bill did: namely limits on collective bargaining. That's partly because it wasn't clear how the state's health secretary would control Medicaid costs using new-found power that restricted legislative oversight (Mills, 2/29). 

(St. Paul) Pioneer Press: U.S. Senator Raises Questions About Prescriptions Written Under Minnesota Medicaid Program
A prominent U.S. senator is raising concerns about the potential for doctors in Minnesota to abuse the Medicaid health-insurance program by prescribing large numbers of painkillers and other medicines.  In a January letter to state officials, Sen. Charles Grassley, R-Iowa, wrote that he found several "shocking" examples of potential abuse in Minnesota from his review of the prescribing habits of certain physicians.… The state has referred two cases highlighted by the Grassley investigation to the state Board of Medical Practice for investigation, wrote David Godfrey, medical director of the state's Medicaid program, in a letter dated Feb. 10. But those referrals predated the Grassley inquiry, according to state officials (Snowbeck, 3/1). 

Minneapolis Star Tribune: Doctors' Prescriptions Raise Suspicions Of Medicaid Fraud
Minnesota officials are reporting a handful of doctors to the state medical board for potential disciplinary action because of the amount of addictive painkillers and potent psychotropic drugs they have prescribed. In a Feb. 13 letter to U.S. Sen. Charles Grassley, R-Iowa, the Department of Human Services said it has reported two doctors for excessive prescriptions and was "in the process of reporting others." The letter was an update to Grassley, a member of the Senate Judiciary Committee who has been investigating whether doctors are bilking the Medicaid system by writing too many prescriptions or are prescribing certain medications more often because of financial ties to drug manufacturers (Olson, 2/29).