The proposed amendment, as it stands, seeks to reduce ED costs solely by penalizing those departments for circumstances outside of their control and thereby reducing their ability to effectively care for their patients.

In the optimal world, many conditions would be effectively treated in an outpatient setting, reducing reliance on expensive emergency department care, saving the system costs and improving the health of the Medicaid population. This amendment does nothing to provide incentives towards moving care of non-emergent or preventable conditions to the outpatient setting. Instead, by reducing reimbursement to emergency departments, it will cause some EDs to close and force others to reduce staffing, leading to increased wait times and causing harm to Medicaid patients. 

The high rates of ED utilization for non-emergent and preventable conditions in the Medicaid population do not reflect a failing of EDs, but rather a failing of a health system where there is serious inequity in morbidity and care access along socioeconomic lines. There are very few (if any) actions an emergency department can take to reduce visits due to non-emergent or preventable conditions. If the goal of the state is to use financial incentives to reduce these types of ED visits, then the state must address the reasons why people seek care for illness or injuries that are non-emergent at the ED. 

Another huge issue with this amendment is that many of the "non-emergent" conditions listed may not be clearly distinguishable from emergent conditions to a lay person. In many cases, the ED is exactly the place where they should be seen, as the emergent condition would require prompt treatment. In other cases, a condition may have been preventable, but the patient's current status requires emergency treatment. In that case, perhaps the MCO could be reasonably seen to be at fault, but how will it help to down-grade the level of reimbursement for the department that is providing appropriate life saving treatment (and thus limiting its ability to continue to provide life-saving services)?

The state should indeed consider why Medicaid patients continue to rely on emergency services as a health safety net, especially given the costs associated with maintaining it. However, weakening the safety net will not fix the underlying issues, and it will only harm the patients dependent upon it.