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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