study didn't state this, but I have to believe that the lack of personal requirement for payment is part of the reason this is the case. Medicaid pays less than any other insurance including Medicare. In fact, Medicare is glorious to deal with compared to state Medicaid payors. I cannot find specifics on non-payors in the ER, but a large percentage of the "Charity Write-offs" done by health systems are Medicaid and people who end up not paying their bills.