The percentage of self-pay patients increased for emergency department, hospital and primary care visits starting in April 2023, when states could begin terminating Medicaid coverage, according to a Nov. 17 study from Epic Research, a division of the EHR company.
Researchers analyzed 34 million hospitalizations, 340 million primary care encounters, and 146 million ED encounters that occurred between January 2017 and August 2023 to determine the proportion of self-pay encounters by the month Medicaid coverage terminations started in each state, according to the report.
From March to August, ED encounters with Medicaid coverage decreased by 2.8 percentage points, according to the report. Self-pay ED encounters increased 2.4 percentage points and 0.3 percentage points for commercial/other ED encounters. The report said this suggests most of the Medicaid ED volume transitioned to self-pay.
Between March and August, the proportion of hospitalizations with Medicaid coverage dropped 2.7 percentage points, coinciding with a 1.5 percentage point rise in the proportion of self-pay hospitalizations. The proportion of hospitalizations with commercial/other coverage increased 1.2 percentage points.
For primary care visits, the proportion of encounters with Medicaid has largely stayed between 14% and 15% since 2017, with a small jump to 16% at the start of the pandemic, according to the report. Self-pay primary care encounters increased slightly over that time frame to 2% in 2019, where it remained until March 2023, when it increased by 0.6 percentage points between March and August. Commercial/other insurance-covered encounters increased 0.5 percentage points between March and August.
Read the full report here.