Florida Is Illegally Limiting How Often Poor People On Medicaid Can Visit The ER

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"Florida Is Illegally Limiting How Often Poor People On Medicaid Can Visit The ER"

shutterstock_ER emergency room

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Florida Gov. Rick Scott’s (R) effort to save his state’s Medicaid program money on the backs of the poor just backfired.

In 2012, the Scott administration lobbied the federal Centers for Medicare and Medicaid Services (CMS) to allow it to limit the number of times that Medicaid beneficiaries can frequent emergency rooms to six visits. The Obama administration rejected that request, arguing that it constitutes a violation of the Social Security Act by placing “an arbitrary limit” on a legally mandated benefit, and that it has the potential to harm poor patients, the Miami Herald reports.

But the Scott administration ignored CMS’s decision and instituted the ER cap after filing an appeal. Now, CMS has responded by warning that it will withhold federal matching funds for Florida’s Medicaid program if the state doesn’t change its tactics.

“We hope the state will realign their Medicaid program with federal standards to avoid this penalty,” said Emma Sandoe, a CMS spokesperson, in a statement.

The fine is expected to be a 10 percent reduction in matching funds in the first year, with an additional five percent cut in subsequent quarters.

The Scott administration argues that limiting emergency room visits is a way to encourage patients to stay out of the costly emergency care departments, and encourage them to use more cost-effective preventative and primary care doctor visits instead. Health care experts agree that primary care is preferable to using the emergency room — but people who enroll in Medicaid for the first time may not understand that from the get-go. Uninsured people typically rely on emergency departments and aren’t used to navigating doctor’s offices. Consequently, Medicaid beneficiaries may take some time to get acquainted with the nuances of the health care system.

It’s also unclear how effective such a cap would be at controlling costs, considering that just one percent of enrollees even use emergency departments six or more times in a year. As such, the cap may end up harming patients who legitimately have to use the ER a disproportionate number of times.

Only a sliver of the poorest Florida residents — parents with dependent children who make just a third of the Federal Poverty Level (FPL) — are eligible for Medicaid in the first place. Florida lawmakers have rejected the Affordable Care Act’s Medicaid expansion.

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