The risk of funding cuts to Medicaid always exists, but it is in the news more than ever right now. While political conversations often focus on the total Medicaid budget, another critical question is how the money will be spent.
Research continues to demonstrate time and time again that investing in preventative care reduces total healthcare spending, yet access to primary care remains a struggle for some Medicaid recipients due to social determinants of health issues.
Emergency Department Utilization Higher for Medicaid Patients
Over 79 million Americans are enrolled in Medicaid, and research has demonstrated that those with Medicaid have significantly better access to care than the uninsured. That said, significant gaps and social determinants of health still impact access to care for Medicaid patients.
Medicaid patients overutilize the emergency department relative to patients with private insurance. ED overuse not only contributes to higher healthcare costs but also missed opportunities to establish strong relationships with primary care physicians.
Studies have been mixed on whether expanding Medicaid decreases ED usage, which gets back to the premise that HOW Medicaid dollars are spent may be more important than the total number.
Many Medicaid enrollees face barriers like limited transportation, lack of health literacy, and provider shortages, which make it harder to access primary care. As a result, they are more likely to rely on emergency departments (EDs) for care that could have been managed earlier and more effectively in an alternative setting.
Chronic Disease Management Starts with Primary Care
Timely preventive care leads to improved outcomes, which is particularly important for patients with chronic diseases, such as diabetes, hypertension, and asthma. Over two-thirds of adult Medicaid beneficiaries have at least one chronic condition, and more than half have multiple chronic conditions.
Consistent monitoring, medication management, and lifestyle counseling—services best delivered through a trusted primary care provider—are critical for Medicaid patients with chronic diseases. When patients are regularly engaged with a provider, chronic conditions are less likely to spiral into costly complications, such as heart attacks, amputations, or hospitalizations.
One of the most overlooked benefits of primary care is the trust and continuity it provides. For many Medicaid patients—particularly in underserved or rural communities—a consistent provider offers more than just medical expertise. It creates a safe space to discuss sensitive issues, address social determinants of health, and navigate a complex healthcare system.
Investments in Primary Care are Critical
Increased primary care spending leads to fewer hospitalizations and emergency visits and ultimately lower total healthcare costs. Investments in primary care can bend the cost curve.
Conversely, cuts in the wrong places can have unintentional consequences that ultimately increase costs.
- When provider reimbursements are reduced, fewer doctors are willing to accept Medicaid, pushing more patients to rely on emergency rooms
- Eliminating social support services like transportation and food reduce access to care, which drives more utilization of more expensive services like the ED and inpatient care over time
- Limiting access to maternity care results in more pregnancy complications and premature births, which increases NICU services
RPM Can Bridge Social Determinants of Health
Remote Patient Monitoring (RPM) is emerging as a powerful tool to extend primary care services beyond the clinic walls—particularly for Medicaid patients who often face barriers to in-person visits, such as unreliable transportation, work constraints, or caregiving responsibilities.
By proactively monitoring chronic conditions like hypertension, diabetes, and heart failure in real time, RPM reduces ED visits. RPM also establishes a usual source of care, which is critical for foundational primary care support. The relationship with a monitoring clinician provides opportunities for clinicians to increase patient engagement, reinforce healthy behaviors, and catch potential issues before they escalate.
A Budget-Friendly Solution
We know RPM reduces costs and can help those with social determinants of health access primary care. Relative to ED and acute care services, RPM is extremely cost-effective. Doubling down on programs like RPM and CCM could yield significant cost savings without making the Medicaid cuts that many providers fear.
Primary, preventive care is not a luxury—it’s essential to building a healthier, more cost-effective system for Medicaid enrollees.
RPM Done Right for Medicaid
Medicaid patients with chronic diseases can greatly benefit from the proactive approach of RPM. However, many have multiple chronic conditions as well as social determinants of health that may require extra clinical monitoring time. If you are short on staffing but looking to better serve Medicaid patients, Optimize’s clinical monitoring services can help. Contact us to learn more.