An analysis of state Emergency Medicaid spending contradicts assumptions about emergency care provided to recent immigrants, researchers from the University of North Carolina at Chapel Hill and the Carolinas Center for Medical Excellence have found.

The study appears in the March 15 issue of the Journal of the American Medical Association. Dr. Annette DuBard, a research associate at UNC’s Cecil G. Sheps Center for Health Services Research, will present the results Tuesday (March 13) at a JAMA media briefing on access to care at the National Press Club.

The researchers report that in North Carolina, the bulk of Emergency Medicaid spending pays for childbirth and pregnancy-related complications for women who do not have coverage for routine prenatal care or family planning services. Emergency care for sudden-onset problems such as appendicitis and traumatic injuries and end-stage complications of chronic conditions such as kidney failure and heart disease represent the remaining costs. Yearly Emergency Medicaid costs represented less than 1 percent of the state’s Medicaid budget.

Emergency Medicaid reimburses hospitals for emergency care of patients who would otherwise qualify for Medicaid but are ineligible because federal law excludes undocumented and legal immigrants who have been in the U.S. less than five years. The Medicaid program does not reimburse non-emergency care or care provided to patients who do not meet Medicaid requirements – most adults without children and immigrants with employer-sponsored insurance.

“There’s a misconception that a lot of the Medicaid budget is going to recent immigrants,” said DuBard, the lead study author. “However, we’re spending money at the wrong end of care. We can make better use of these health care dollars by increasing access to preventive care, which would alleviate demand for costly emergency care and improve the health of this population,” DuBard said.

To understand trends in North Carolina’s Emergency Medicaid spending, DuBard and co-author Dr. Mark Wayne Massing of the Carolinas Center for Medical Excellence in Cary, N.C., analyzed all claims reimbursed by the program from 2001 to 2004. The University of North Carolina Preventive Medicine Residency Program supported the research.

State Emergency Medicaid payments increased 28 percent during the study, from $41.3 million in 2001 to $52.9 million in 2004, though the spending growth was lower than the increase in total Medicaid spending (35 percent).

More than 48,000 individuals, including 3,883 children, received care covered by Emergency Medicaid during the study period. Just over 95 percent of all patients were women, 89 percent were between 18 and 40 years old and 93 percent were Hispanic. More than 99 percent of patients were recorded as undocumented immigrants, but this finding may not reflect true immigration status, DuBard said. “For the purposes of Emergency Medicaid reimbursement, there is no incentive for patients or hospital staff to complete the additional documentation required to confirm legal immigration status,” she said.

Childbirth and pregnancy complications accounted for 83 percent of spending and 91 percent of hospitalizations. Outside of pregnancy-related care, injuries accounted for 1/3 of spending and 1/5 of hospitalizations. Other common conditions requiring emergency care were kidney failure, appendicitis and gallbladder disease. Among patients 40 years and older, stroke, congestive heart failure and heart attack were also leading reasons for hospitalization.

“Emergency Medicaid essentially functions as catastrophic coverage for a population with very limited access to primary and preventive healthcare,” said DuBard, who is also a family physician at a federally supported community health center where 40 percent of patients are uninsured.

States with high immigration rates, such as North Carolina, have seen a rapid rise in Emergency Medicaid costs, according to the federal Government Accountability Office. Many states with established immigrant communities extend full Medicaid benefits to legal immigrants during the five-year eligibility gap, and 11 states provide coverage for undocumented children or pregnant women. But immigration growth states such as North Carolina, whose foreign-population grew 274 percent in the 1990s, often lack a safety net for recent immigrants, DuBard said. As a result, an immigrant who has suffered a disabling stroke may endure lengthy and expensive hospital stays because hospital staff cannot arrange a discharge plan, she said. Or mothers who develop diabetes during pregnancy may not receive the care they need, and be at higher risk for childbirth complications or infant health problems.

“In light of the extent of Emergency Medicaid spending for pregnancy-related emergencies, and the fact that children born to mothers covered by the program receive full Medicaid, it may cost less to provide full coverage for contraceptive and prenatal care,” DuBard said. Injury prevention initiatives, preventive care and chronic disease management would also help manage growth in Emergency Medicaid expenditures, she added.
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EMBARGOED FOR RELEASE:
9 a.m. ET, Tuesday, March 13, 2007

Contact: Becky Oskin
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University of North Carolina at Chapel Hill