Washington state legislature is among the legislatures in the country that are feeling the serious effects of the currently ongoing recession. Just like the others, Washington looked at Medicaid program as one of the places where money should be cut to help contain the budget shortfall. However, the state took a new approach after it directed the Health Care Authority in Washington to look for 72 million dollar savings from the emergency department utilization, specification from patients who usually over utilize the emergency department for medical care that is non emergent.

If you have ever been at the emergency department, then you know too well than anybody else that Medicaid patients usually keep coming back now and then. To add salt to the injury, they usually come for routine or trivial complains. So, the legislature came up with a plan of generating a list of diagnoses that are non emergent and simply avoid paying for the patients after their third visit. Now, the Health Care Authority had a hard target which they had to achieve to help the state save $72 million. They started by looking at frequent ED visitors and the kind of complaints they made. It dawned on them that they couldn’t achieve their objective by simply refusing payment for toothaches and runny noses, which are the most common Medicaid non emergent visits.

The effects of the unapologetic and open rationing

As a result, the authority decided to re-define non- emergent diagnoses as well as recalculating the savings. Unfortunately, this was also not enough and they decide to add more names to their non- emergent list until they achieved a figure of money they wanted. The newly created listed now has approximately 750 of the non- emergent diagnoses and you can guess right that the state won’t be paying for this. This includes routine, non- emergent and trivial routines like viral infection that is otherwise not specified, steep throat, viral enteritis, scabies and migraine headache. So, if you turn up at a medical center with either of these conditions, you will re- rioted to primary care physicians or clinics.

The effects of the unapologetic and open rationing

However, this is not all as there are also other so called ‘non- emergent conditions’ that the state won’t be paying for either. These include chest pain, asthma exacerbation – acute, abdominal pain, hypoglycemic coma, acute cholecystitis, pneumococcal pneumonia, kidney stone/ calculus of ureter, pseudonomal pneumonia, syncope and collapse, streptococcal septicemia, salmonella enteritis and a few others. This list is a little ridiculous and what made its way into the list was done in a haphazard and arbitrary manner. With the state having decided that it will not be paying for some of these diagnoses, hospitals and docs have no idea of what to do rather than just offer the services. Everyone knows too well that this list is simply wrong and with this kind of unapologetic and open rationing, the layperson will have to pay more for medical expenses.