In May, HHS’ Inspector General released a study that presented some pretty
depressing news – almost three-quarters of children on Medicaid in nine states
are not receiving all of the medical, vision and hearing examinations (the
study did not look at dental) that federal law (through the Medicaid EPSDT
benefit) requires.
It has long been recognized that low-income children are
at greater risk of being in ill health, often facing vision, hearing and speech
problems, and other developmental obstacles. The importance of providing these
children with early and regular screenings to identify and address problems
before they become worse is clear. Medicaid EPSDT provides this comprehensive
approach to kids’ health by requiring that every child receive periodic
preventive medical assessments that include physical exams, vision and hearing
tests, dental exams, immunizations, lab tests (for example, to assess blood
lead levels), and health education. Additionally, EPSDT provides necessary
diagnostic and treatment services to address concerns identified in the
screenings.
The newly released report shows that the states examined
(Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, Texas, Vermont,
and West Virginia) have a ways to go to meet the promise of EPSDT. Among these
states, even for children who received a medical screening, 60 percent did not
receive all of the services they should have (with lab tests most commonly
skipped). States in the study reported efforts to improve these results,
including outreach to families, but it is not clear what the scope of those
activities were (handing out flyers versus hands-on assistance to families).
The Inspector General’s report recommends that states
report hearing and vision screenings and that CMS work with states to find
incentives to increase doctor participation and improve outreach efforts to
families. Experts working on this issue have also recommended providing states with best
practices, creating better linkages with groups routinely in contact with
children, offering better education to providers, increasing provider
reimbursement, and requiring better data collection and reporting.
Efforts in this area may also be helped through health
reform. Included in the law is a provision that requires private health plans to
offer these types of screenings (through Bright Futures, a compatible set of
preventive services recommended by the AAP) at no cost. With
many more children now in the mix, there are increased incentives to make the
EPSDT screening component the best it can be for all children.