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Running head: MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES

Medicaid Recipients Use of Emergency Facilities Christine Demler NURS 340

2 MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES Medicaid Recipients Use of Emergency Facilities Medicaid recipients are considered a vulnerable population. A vulnerable population is defined as social groups who have an increased relative risk or susceptibility to adverse health outcomes (Flaskerud and Winslow, 1998, pg. 69). Medicaid recipients face several barriers when trying to get primary care and as a result they visit the hospitals Emergency Room (ER) more often than those with other types of insurance. Caroline Steinberg, a vice president at the American hospital Association, said the research does show how people with chronic conditions who do not get adequate primary care can find themselves at the emergency room with complications (Heavey, 2012). Most Medicaid recipients are less likely to have a primary care physician than privately insured individuals. Medicaid recipients are generally low income, pregnant women, the disabled, or the elderly that are receiving Medicare and are also low income. Vulnerability There are several factors that contribute to the vulnerability of this population. Medicaid patients face multiple barriers when it comes to their healthcare. Most have a hard time with primary care. Whether it is making it to the appointments on time, the transportation to get there, or have a hard time reaching the doctor by phone. It is less likely for Medicaid recipients to even have a primary care physician. There is also long wait times at the physicians office and limited office hours that also contribute to this population not seeking or utilizing a primary care physician. All these factors contribute to the vulnerability of this population. Awareness of this population

3 MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES I am very aware of this population and have worked them it for a number of years. I live in a rural community with a large number of low income individuals. I was a homecare nurse for more than 10 years. I have personally seen how this population has been treated while at the ER. I have been called multiple times by patients or their families who were in the ER with an actual medical emergency and were being treated with no respect or not treated at all. It was only when I showed up and introduced myself, did they get the treatment that they needed. In many of the rural areas surrounding where I live, there are no walk in clinics or urgent care available for people to seek the needed after hours or weekend care. These people have no other resort then to go to the closest ER for treatment. I am now a Nurse Case Manager (NCM) and have clients in rural areas all over the state. Quite a few of my clients are known as frequent flyers to their local ERs, and have to call me in order for me to contact the ER and explain who I am and why I have sent them before receiving any kind of care at all. In many situations the staff has already made assumptions about the patient. That is when I have to go in and act as a buffer to make sure that treatment is given properly to my clients. After researching the vulnerability of Medicaid patients receiving poor health care denotes that what I have experienced with many of my clients is backed by research. I find this very disheartening as a nurse, a medical professional, and as a member of the human race. I would hope that if I ever fell upon hard times and required Medicaid assistance, I would not be pre-judged and treated badly simply because of my insurance. I know from working with this vulnerable population, they would not have chosen to be in the situation they are in. Many of the Medicaid patients that are in need of medical

4 MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES attention are retirees that worked all their lives. Many retired, became ill, and had lost everything they had because of the medical bills which were not covered by their employer backed retiree insurance policies. Now these individuals are where they are at and there is no coming back for them. They will need the Medicaid assistance the rest of their lives. Demographics Medicaid recipients have to meet some requirements to be eligible. Individuals that are eligible could be women who are pregnant, any child under the age of 19, any persons that are considered low income, which is defined as someone who makes less than about 15,000/per year, are disabled according to the Social Security Administration, or any elderly person who is currently receiving Medicare and is low income (Department of health and hospitals, 2013). These are the federal standards each state has their own adaptations, inclusions and exclusions to these standards. They have the right to set their own enrollment criteria. Medicaid recipients utilize the Emergency Department at the hospital more frequently than people with private insurance. Some of the reasons for this are due to multiple barriers to them getting or using primary care physicians. Many Medicaid recipients are low income and either, do not have or cannot get the transportation to the office. Trying to reach the physician by phone, long wait times in the office and limited office hours all contribute to Medicaid recipients using the local ER department for their primary care. The disabled, most children under age 19 and the elderly that are also low

5 MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES income make up a large portion of all Medicaid recipients. All these factors add up to make this a vulnerable population.

6 MEDICAID RECIPIENTS USE OF EMERGENCY FACILITIES References Department of health and hospitals, (2013) About Medicaid http://dhh.louisiana.gov/index.cfm/page/220/n/20 Heavey, S. (2012, July 11). Update 1-medicaid patients turn to hospitals for emergencies, not routine care. Retrieved from http://www.reuters.com/article/2012/07/11/usa-healthcare-medicaid-emergencyupdate-idUSLZE8IBG6H20120711 Flaskerud, J., & Winslow, B. (1998). Conceptualizing vulnerable populations in healthrelated research. Nursing research. 47(2), 69-72 Preidt, Robert (2012). Medicaid Patients go to the ERs more often: Study. HealthDay