Medicaid GAO Report Finds Services Lacking for Children
Families of children enrolled in Medicaid are not "sufficiently informed" of their entitlement benefits and "many" children are not receiving mandated care, a new GAO report finds (GAO, "Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health Screening Services," July 2001). According to the AP/Atlanta Journal-Constitution, under federal law, Medicaid enrolled children must be provided with preventive health care under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service and also visited (AP/Atlanta Journal-Constitution, 8/14). This component of Medicaid requires children to receive periodic screening, such as vaccinations and age appropriate laboratory tests, as well as vision, dental, and hearing services, even if such benefits are not required for the rest of a state's Medicaid population. EPSDT also requires states to ensure the availability and accessibility of the benefits and to assist Medicaid beneficiaries and their parents in obtaining the services (CMS Web site). In auditing the number of children who are eligible for preventive care under Medicaid, but not receiving it, the report found a "comprehensive review" is not possible, as state reports to the Centers for Medicare and Medicaid Services (formerly HCFA) on the delivery of EPSDT services are "unreliable and incomplete." This is particularly true for children in Medicaid managed care plans, the study found. The "most reliable" data is from studies on "specific" benefits, such as dental or lead screening services.
In conducting the study, GAO reviewed state reports submitted to CMS on EPSDT services by California, Connecticut, Florida, New York and Wisconsin, which were selected because they represented different regions of the country, have a large number of children in Medicaid managed care plans and have a reputation for having an "innovative" EPSDT program. Part of the "difficulty" states have in collecting data on the delivery of EPSDT serives is related to the use of capitated managed care. Under such a system, the state, which pays a monthly fee irrespective of services provided, must rely on the health plan to collect data on provided services. Under traditional fee-for-service Medicaid programs, the state could collect such information as part of the payment process. For its part, the federal government's efforts at tracking delivery of EPSDT have focused on changing the format and requirements of the state reports. While such changes are a "positive step," the report found they do little to address the problems states face in collecting data (GAO, "Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health Screening Services," July 2001).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.