June 18, 2020 Dear DMAS:
It has come to my attention that the Virginia Department of Medical Assistance Services (DMAS) has proposed reducing Medicaid reimbursements for emergency care in cases they have deemed “Preventable” as part of a plan to reduce budgetary costs for healthcare in the State. The plan involves limiting reimbursements for these cases to Emergency Physicians to $14.98; about the price of a fast food meal. 

To put it bluntly, people will die. 
The Prudent Layperson has never been a reliable source to determine what constitutes an emergency. These patients should never be out in a position with their limited knowledge to determine if their illness represents an emergency.  Hospitals and Emergency Departments are bound by Federal EMTALA Rules to evaluate all people who present to the emergency department. Your proposed cuts only serves to punish the healthcare providers who are bound by federal law to see patients.

How do you expect a prudent layperson to understand the nuances of a 17 page list of diseases, when doctors often have to perform multiple blood tests and radiology studies to evaluate and diagnose? 

Unfortunately the patient’s most directly affected by this are the patients that are already at risk due to poor access and availability for primary care. Passage of this low only serve to further decrease that access leading to an increase in the sickness of this population.

Sincerely, 

Ronak Shah, MD