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On Jan. 17, democratic lawmakers ‘blasted’ a decision by Bush administration, which could have limited emergency services for the Medicaid beneficiaries, as reported by the Wall Street. According to a letter sent by Bush administration to the state Medicaid directors, Bush administration was saying that the managed care organizations could restrict and limit emergency service coverage for Medicaid beneficiaries. This decision removes the previous restrictions that were established back in 1997 by the Balanced Budget Act of 1997, in the rules issued in January 2001 by the Clinton administration and in June 2002 by Bush administration.

According to the 1997 law, a state can require that Medicaid beneficiaries enroll either in the HMOs or any other MCO. But the law requires that MCOs must provide emergency service coverage in a case which a ‘prudent layperson’ could consider as an emergency. In addition, the same law also allows the Medicaid beneficiaries who are enrolled in the MCO to access emergency services at the most nearest provider immediately. But the administration declined that a state could place limitations on emergency service coverage for facilitating primary health care and preventive health care to be used for appropriately.

Sex democratic lawmakers oppose the decision

According to Rom Scully, CMS administrator, it is necessary for states to be flexible in setting reasonable limits on emergency room visits as a way of encouraging patients to use emergency rooms more appropriately. In response to this, six lawmakers from the democratic side sent a letter to Tommy Thompson, who is the HHS Secretary arguing that this decision could cause an ‘exorbitant burden’ on most facilities in addition to forcing most Americans to filing for bankruptcy.

In their argument, the democratic also said that the decision was a violation of the 1997 law provisions. Rep. John Dingell also added his voice on the issue saying that this decision would also be a burden to hospitals. The president of American College of Emergency Physicians, George Molzen also said that emergency departments are currently at a breaking point. The move that the Bush administration was about to take would highly likely erode hospitals ability to offer lifesaving care. According to a letter sent to Thompson separately, Senator Bob Graham was quick to note that such a decision could unravel the protections on patients.

Louisiana response

In other related news, Picayune of New Orleans Times reported that despite this decision reached at by the Bush administration, Louisiana was not planning to limit visits to the emergency room for the Medicaid beneficiaries. David Hood, the state health secretary said that they were considering other proposals of controlling costs first before moving to offer limitations on reimbursements offered by Medicaid for emergency services. He said that such a limit on ER is like a metax approach and they would like first to consider other approaches. In case these new approaches do not offer a better solution, they would consider the decision by Bush administration.