Impact of Policy Changes on Emergency Department Use by Medicaid Enrollees in Oregon

In Oregon, emergency department (ED) visits by most Medicare enrollees fell 18 percent, following implementation of a $50 co-payment.

From 2003 to 2004, the state of Oregon experienced drastic cuts in its Medicare expansion program, Oregon Health Plan (OHP) Standard: enrollees lost coverage if they could not pay premiums; there were new co-payments for primary care visits, emergency department use, and hospitalization; and, the state eliminated coverage for outpatient mental health and chemical dependency. The changes did not affect enrollees in a separate Medicare plan, OHP Plus.

This study reports changes in ED use following the cuts to OHP Standard benefits. Because the cutbacks allowed primary care providers to refuse services if patients could not make the new co-payments, the authors surmised there might be an increase in ED visits. The authors examined the overall rate of ED visits per enrollee, the number of ED visits leading to hospital admission, and injury-related visits. In addition, the authors examined ED visits related to three behavioral health categories: alcohol use, drug use and psychiatric conditions. Enrollees in OHP Plus were the control group.

Key Findings:

  • Overall ED use and visits related to psychiatric conditions fell 18 percent for OHP Standard enrollees, compared to enrollees in OHP Plus, following the cutbacks.
  • Following the restoration of coverage for chemical dependency, there was a 32 percent increase in ED visits related to drug use.

In 2003, Oregon saw the number of OHP Standard enrollees fall by nearly half. By August 2004, the courts and the state legislature had restored most benefits. The findings presented here support previous studies showing similar decreases in ED use following the establishment of co-payments.