The notion that Medicaid patients rely heavily on hospital emergency departments for routine care is false, argues a recent recent study by the Center for Studying Health System Change, which looked at a series of common misapprehensions about emergency department use.

Only 10 percent of emergency department visits by nonelderly Medicaid patients were for non-urgent symptoms, compared to seven percent of visits by nonelderly, privately insured patients, the study’s findings showed. More than half by nonelderly Medicaid and privately insured patients were for genuinely emergent or urgent situations, defined as those needing attention immediately or within one hour, respectively.

A significant opportunity to reduce emergency department visits among children would be to target a small group of conditions that account for more than half of visits: acute respiratory infections, along with other common infections, and injuries.

“Very few other condition groups account for a large enough share of visits that, if redirected to other care settings, could have a real impact on patient volume in emergency departments,” the report says. “This is strong evidence supporting the idea that settings other than emergency departments could manage a large share of visits by children.”

Additional findings were:

  • Medicaid enrollees age 0 through 64 had 45.8 emergency department visits per 100 enrollees compared to 24 visits per 100 privately insured enrollees.
  • There were 5.6 emergent emergency room visits per 100 nonelderly Medicaid patients compared to 3.6 per 100 privately insured patients.
  • There were 10.4 semi-urgent emergency room visits per 100 nonelderly Medicaid enrollees compared to 5.5 per 100 privately insured patients.
  • Acute respiratory and other common infections and injuries combined accounted for more than half of all emergency department visits for children age 0 through 12 years.
  • Nonelderly adult Medicaid enrollees represent higher emergency room use across all medical conditions, suggesting health-status differences with privately insured adults.


Kip Piper is a Medicaid, Medicare, and health reform consultant, speaker, and author.  For more, visit  Follow on Twitter at @KipPiper and connect with Kip on LinkedIn.