(New England Journal of Medicine)

May 18, 2012

Emergency Departments, Medicaid Costs, and Access to Primary Care—Understanding the Link

by Arthur L. Kellermann and Robin M. Weinick

In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries "when those visits are not necessary for that place of service." To identify unnecessary visits, the state proposed a list of approximately 500 diagnosis codes (see examples in the tableSelected Diagnoses (with ICD-9 Codes) from the Washington State Health Authority's List of "Nonemergency" Conditions.). The proposed rule would apply to all Medicaid beneficiaries, irrespective of age, disability, or place of residence (such as a nursing home)—even if the patient, the child's parent, or the nursing home staff believed that ED care was needed....

The remainder of this op-ed can be found at

This commentary originally appeared in New England Journal of Medicine on May 18, 2012.