Honestly, ER abuse is one of the biggest wastes of Medicaid money. WITHOUT QUESTION, my patients with TennCare are the most likely to go to ETCH or an outlying ER with cold symptoms, minor injuries, etc that are much more appropriately seen in my office. However, the ER is free and they don't need an appointment, so there's no deterrent to wasting taxpayer money and the ER staff's time.
Most private insurance carries a much higher copay for ER visits, so they will wait and see me unless it's a true emergency.