July 13, 2024

MDG – 500

Trailblazing Healthy Quality

Aging Out of EPSDT – Part VII: Taking Responsibility

3 min read

For the last six posts, we’ve talked a lot about all of the factors that go into making the transition from child with special needs (covered by the Early and Periodic Screening, Diagnosis, and Treatment — EPSDT — program) to adult with special needs a particularly traumatic event for low-income families. We’ve talked about the states that declined the Medicaid Expansion offered by Obamacare, and about the failures within Medicaid that make the non-expanded version fail so many low-income adults with disabilities. We’ve talked about the costs this can have on the families who have to pay for their newly-adult children with disabilities out-of-pocket.

What we haven’t talked is how much these failures are costing all of us. Not just in some sort of moral-outrage kind of way, either, but in terms of actual tax money out of our pockets.

Emergency Treatment is a Right…

Treatment for medical emergencies became a universal right in the United States in 1986 — if anyone, insured or not, shows up at a hospital ER with a life-threatening emergency, the ER is legally obligated to treat them until their lives are no longer in danger. If that person is uninsured, has no money, and the hospital cannot convince Medicaid that they should be covered, the hospital uses a perfectly valid and legitimate technique called ‘price shifting’ to essentially bill Medicaid anyway, by charging slightly more for all of the other Medicaid-covered services they offer.

… That We All Pay For

That sounds like it might be a no-loss situation for the taxpayer, but that couldn’t be further from the truth, and here’s why: medical emergencies cost an unbelievably greater amount than medical maintenance. The cost to keep someone with severe asthma on a potent inhaler might run several thousand dollars every year, plus another twelve thousand for a couple of interventions. The cost to resuscitate, medicate, observe, and finally release someone whose untreated severe asthma led their sister to call 911 and get the paramedics will easily top $100,000.

And that’s for just one such event. Many relatively common forms of disability, severe asthma among them, commonly put their sufferers in the hospital several times every year when they go untreated. So the cost of covering one of these families under Medicaid would run perhaps $20,000, and the cost of not covering one of these families can easily exceed $520,000. When you multiply the half-million dollar difference by rough estimate of 25,000 Americans who have severe disabilities and aren’t covered by Medicaid or any other insurance, you’re suddenly looking at $12.5 billion that the American taxpayers are paying so that some states can pat themselves on the back for ‘reducing costs’ by cutting coverage to young adults aging out of the EPDST program.

The Fiscally Responsible Thing to Do

A decade or so ago, ‘renegade researcher’ Malcolm Gladwell authored an article in the New York Times called Million Dollar Murray, describing how one specific homeless man cost the city of Las Vegas over a million dollars in hospital costs over a 10-year period. Since that article, several entities have recognized the value of simply paying for people who can’t pay for themselves. The state of Utah’s Housing First program, for example, simply gives small-but-complete houses to the chronically homeless, charging them a meager $50/month in rent. Why? Because a study showed that one chronically homeless person cost the state an average of $19,000/year in jail, hospital, and other services — but it cost only $8000/year to give them a house and assign them a case worker.

There are hundreds of similar examples all over the country — cities, counties, and occasionally entire states that realize that simply giving service to the people who need it most is the genuinely fiscally responsible option in the long run. And while you might be able to make a pretty solid-seeming argument about bootstraps and pulling-up when it comes to homelessness or drug use, it’s a pretty rock-solid bet that you can’t really ask someone with a chronic disability to ‘man up’ and deal with it on their own, making it not just fiscally responsible, but morally responsible as well.

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