State limits non-emergency ER visits by Medicaid recipients

Sep 22, 2011

The state of Washington is limiting Medicaid recipients to three non-emergency Emergency Room visits per year, beginning October 1st.

Visits over the limit won't be covered by Medicaid, and hospitals will be allowed to bill patients for those services.

Washington Health Care Authority Director Doug Porter says this isn't just another budget cut, but an attempt to address a serious problem:

“Non-emergency issues and chronic conditions should be treated by a primary care provider, not by an expensive visit to hospital Emergency Rooms.” 

The Health Care Authority spent nearly $98 million on a total of 327,965 hospital Emergency Room visits last year. The Legislature estimated the state could save $34 million a year, about a third of that, with the new limit on non-emergency visits. 

Exceptions to the three visit limit:

  • Children placed by the department in out-of-home care with foster parents, relatives or other caregivers
  • Visits for mental health diagnoses or for clients seeking detoxification services
  • Visits that result in an inpatient admission, emergency surgery or admission for observation

Porter says the state is working with hospitals to find ways to refer non-emergency patients to more appropriate facilities.