HCPF: 1 in 4 Medicaid beneficiaries rely on emergency department for care at least once a year


Boram Kim


The Colorado Department of Health Care Policy and Financing (HCPF) recently released emergency department (ED) utilization data for the state’s Medicaid program and found that each year, approximately 25% of Health First Colorado members visit the emergency room at least once for care. Some 4% of members visited the ED 6 or more times per year, accounting for 21% of all ED visits. 


Stay one step ahead. Join our email list for the latest news.



The report tracked 1,455,303 total visits from March 2019 through March 2021 and found that trips to the ED declined and were lower (618,839) in the first year of the pandemic compared to 2021 (836,464). 



The report said that 5% of ED visits were potentially preventable because they were chronic and acute conditions that could have been treated in primary care settings and managed over time. These conditions include complications from diabetes and hypertension, congestive heart failure, pneumonia, asthma, and urinary tract infections. 

HCPF attributed ED utilization for non-acute conditions to factors such as convenience, cost-trade-offs, preferences, and barriers, like transportation. The report outlined some potential ways to reduce preventable visits through continued focus and collaboration with hospitals and their surrounding primary care medical providers. 



HCPF’s case study of Colorado Access, a state Medicaid plan serving the highly concentrated populations of Denver and its surrounding Adams, Arapahoe, Douglas, and Elbert counties, found that utilization rates were higher in these areas than in other regions of the state for certain chronic conditions. These include asthma, diabetes, and chronic obstructive pulmonary disease among others. 

“Colorado Access’s strategy to reduce preventable ED visits emphasizes supporting members with chronic conditions to manage their care in the best location for their needs,” read the report. “They have done this by primarily focusing on improving wrap around support for members and expanding collaborations among hospitals and primary care clinics. It is important to note that while members with chronic conditions are not driving the total number of ED visits in these regions, they do have higher rates of ED utilization and often may be better served through a medical home.

The hospital and clinic collaborations promote access to primary care and faster follow up appointments, medication adherence and education on how to manage conditions, and assistance with social and economic needs. They also share real-time data to better coordinate care for members.” 



The report cited higher ED utilization rates for members who are impacted by social determinants of health. Unhoused members were over 6 times more likely to utilize the ED than those with stable housing due to exposure to violence and traumatic injury, poor health, substance use disorder (SUD), and challenges with consistently accessing providers.