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APHA Scientific Session and Event Listing

C. Annette DuBard, MD, Preventive Medicine Residency Program/ School of Public Health Dept. of Health Policy and Administration, University of North Carolina, 1621 Spring Lily Lane, Hillsborough, NC 27278, 919-643-1674, annettedubard@hotmail.com and Mark W. Massing, MD MPH PhD, Carolinas Center for Medical Excellence, 100 Regency Forest Dr, Suite 200, Cary, NC 27511.

Context: Undocumented immigrants and legal immigrants who have been in the US less than five years are excluded from Medicaid eligibility, with the exception of limited coverage for emergency conditions (“Emergency Medicaid,” EM). North Carolina's immigrant population is growing rapidly, but little is known about health services utilization by this population, or the conditions for which EM coverage has been applied. Objective: To describe Emergency Medicaid utilization by recent and undocumented immigrants, in terms of client characteristics, diagnoses, and recent spending trends. Methods: Descriptive analysis of North Carolina Medicaid administrative data for all claims reimbursed under EM eligibility criteria 2001- 2004. Principal diagnosis codes were categorized to identify frequent emergency conditions. Results: 48,391 unique individuals received services reimbursed under EM during the four year period. 99% of clients were undocumented, 93% Hispanic, 95% female, and 89% in the 18-40 year age group. Of 91,520 paid claims in 2004, 64% were pregnancy-related. Excluding pregnancy, frequent diagnostic categories for adults were chronic renal failure (32%), injury (13%), gastrointestinal (12%), and cardiovascular (9%). Injury accounted for 32% of pediatric claims. NC EM spending grew from $39.4 to $52.9 million from 2001 to 2004. Conclusion: Pregnancy-related services for undocumented immigrants account for the bulk of Emergency Medicaid spending in North Carolina, but spending for non-pregnant children and adults, including the elderly and disabled, is growing at a faster rate. Improved access to contraceptive services, injury prevention, and better coordination of chronic disease care for this population could favorably impact demand for emergency medical services.

Learning Objectives:

• Understand eligibility criteria for Medicaid reimbursement of emergency medical services provided to recent and undocumented immigrants
• Appreciate the magnitude of spending growth under the emergency Medicaid program for North Carolina, a state experiencing rapid immigrant population growth
• See demographic characteristics of client population receiving services reimbursed under Emergency Medicaid, and frequency of conditions requiring emergency treatment by age group
• Discuss strategies that may reduce demand for Emergency Medicaid coverage while better meeting the needs of this population

Keywords: Immigrants, Medicaid

Presenting author's disclosure statement:

Not Answered