Reducing Medicaid Emergency Department Use: Increase Accessibility, Not Copays

Executive Summary

Emergency department care, one of the most frequently cited drivers of health care costs, has become a major target for cost sharing policies. The stereotypical “frequent flyer” who uses the emergency department (ED) for every cough and sniffle has become a powerful, but unwarranted symbol of inefficient spending driven by poor patient decision-making. Though often used to justify higher cost sharing on ED use, the common perception that ED overutilization drives wasteful spending is likely overblown, while the “solution” of raising copays does little to address the systemic factors contributing to the ED’s expanding role in our health care system. This issue brief reviews some of the problems related to ED co-pays, especially in the Medicaid context, and evaluates the efficacy of promising alternatives states have implemented to successfully reduce ED utilization while improving care coordination and quality.