Treating an Ailing System: 
Revitalizing Medicaid for Emergency Services

To view Wisconsin ACEP's white paper on revitalizing Medicaid for emergency medical services, please click here.

Community lifeline -- The emergency department, and the physicians who work there, literally are a lifeline for the entire community.  Much like the police and fire departments, emergency departments are an essential public service for everyone, but specifically serve as Wisconsin's health safety net for our economically disadvantaged, uninsured, and underinsured citizens.

All patients cared for -- Unlike other medical providers, emergency physicians are required by federal law to see all patients who come to the emergency department, regardless of their ability to pay.

Wisconsin Medicaid underfunded -- Because Medicaid payments to emergency physicians do not adequately cover the cost of the care they provide, the increasing number of Medicaid patients is draining resources available in the emergency department.  In fact, Wisconsin's Medicaid payment rates for emergency services are among the lowest in the nation -- lower than all but two other states.

An example of the problem -- Emergency department physicians bear a significant share of the cost of providing care to Medicaid patients.  For example, after providing three intensive hours of life-saving care to a Medicaid patient (e.g. a heart attack patient, stroke victim, etc.), an emergency physician is reimbursed $37.40 -- a rate of only $12.47 per hour.

Dwindling services -- Inadequate Medicaid payment rates are leading to devastating consequences in Wisconsin and other states including overcrowding, increased waiting times, more frequent ambulance diversions, decreased availability of services provided by specialists, and, ultimately, the elimination of hospital emergency departments.

A good solution -- Wisconsin should replace its abnormally low Medicaid rates with those used by Medicare for emergency services covered by Levels I-V of the Evaluation/Management codes.

Limited cost & possible funding source -- The costs for this rate adjustment would be limited, but the benefits to the health care safety net would pay significant dividends to the entire community.  Possible sources of funding for our plan include increasing the fines for drunk driving offenses, traffic violations, and seat belt violations.

Preserves the healthcare safety net for all -- By taking this proactive measure to address our shortfalls, Wisconsin can continue to provide quality emergency medical care for all of our citizens, both the poor and those with financial means.