Transcript for the audio podcast:
Preventive Screenings for Medicaid Children
From the Office of Inspector General of Department of Health and Human Services
[Roberta Baskin] I'm Roberta Baskin, Director of Media Communications, speaking with Ann Maxwell, Regional Inspector General for our Office of Evaluation and Inspections, to discuss the report titled Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services. So, Ann, let's start with what the required preventive screening services in Medicaid are?
[Ann Maxwell] Thanks, Roberta. Medicaid provides a preventive child health benefit for children under the age of 21. It's known as the Early and Periodic Screening, Diagnosis, and Treatment benefit, or EPSDT for short. The screening services - often called 'well-child checks' - are meant to screen eligible children at early and regular intervals. This is to avoid or minimize childhood illnesses. These well-child checks cover four health-related areas - medical, vision, hearing, and dental.
[Roberta Baskin] And what's included in that?
[Ann Maxwell] The medical screening should include five components: one, a comprehensive health exam and developmental history; two, a comprehensive unclothed physical exam; three, appropriate immunizations; four, appropriate lab tests; and five, health education. If the well-child check finds anything concerning, the EPSDT benefit provides for diagnosis and treatment.
[Roberta Baskin] And what led you to look at these types of screenings?
[Ann Maxwell] Sure. The OIG had been in this area before, actually. We had issued a report in 1997 that found 60 percent of children enrolled in Medicaid managed care plans didn't receive their required screenings. Also, a number of other organizations, like GAO and the National Health Law Program, found that children weren't receiving EPSDT services.
[Roberta Baskin] So, you decided to check-up on these check-ups to see if there had been any changes since your last review?
[Ann Maxwell] Yeah, exactly. We thought we could add new information by looking at what was provided during the medical vision and hearing screenings. No other studies have looked at vision and hearing screenings, so no one really could say whether children were getting their hearing or vision checked.
[Roberta Baskin] So how'd you go about this new study?
[Ann Maxwell] We looked at a sample of 345 children, all the way from infants to teens, in nine different states. These children were expected to receive at least one screening during the year, which was roughly 2007, depending on each child's birthday. We requested medical records from the children's providers and reviewed those records to see whether each child received any of the screenings. We only looked at medical, vision, or hearing screenings. If a child received a medical screening, we checked whether the child received all five components of the screening.
[Roberta Baskin] And how'd you decide which nine states to focus on?
[Ann Maxwell] We chose a mix of both big and small states and states that reported high and low levels of EPSDT participation.
[Roberta Baskin] And this time what did you find?
[Ann Maxwell] Unfortunately, the story is pretty much the same as it has been in previous studies. In the nine states we reviewed, 76 percent of children didn't receive all of their required medical, vision, or hearing screenings when they should have. This means that nearly three million children weren't getting all of their well-child checks.
[Roberta Baskin] And when the screenings did take place, were they done properly?
[Ann Maxwell] There was a problem there as well. We found that for nearly two million children who did receive a medical screening, nearly 60 percent of the screenings were incomplete. Meaning, that the well-child checks didn't have all five of the required components. Most often, children were missing appropriate lab tests, such as blood lead tests. Children with elevated levels are at risk of decreased intelligence and behavior problems. Finally, we found that all of the nine states were trying to increase the number of children who get their well-child checks and to increase the number of completed medical screenings.
[Roberta Baskin] Well, that's good news! How were states trying to make the improvements?
[Ann Maxwell] Great question. They are trying to increase the number of children who get their well-child checks, and they're doing this by using three main strategies. First, to contact families to remind them when the screenings are due. Second, outreach to the public and other state agencies, like Head Start. And third, a few states mentioned incentive programs to encourage doctors to get children in the door. States also had strategies to get doctors to provide complete medical screenings, mainly by informing and educating them about the required components.
[Roberta Baskin] Those sound like good strategies. How big a challenge is it to get children in the door in the first place?
[Ann Maxwell] It's a challenge. That was a barrier that the states discussed. The barrier that often comes up is the idea that children should only go to the doctor when they're sick and that well-child visits aren't really necessary. Many people don't realize the benefits of preventive care. It's a very difficult position for the states to be in.
[Roberta Baskin] Since the Centers for Medicare and Medicaid Services is responsible for this program, what recommendations did you make to them for improvement?
[Ann Maxwell] We made four recommendations to CMS. First, we recommended that CMS require states to report vision and hearing screenings. This would make it easier to tell if states were actually making improvements. Second, we recommended that CMS should collaborate with states and doctors to develop effective strategies to encourage participation by beneficiaries. Third, CMS should collaborate with states and doctors to develop education and incentives to encourage complete medical screenings. And lastly, CMS should identify and distribute promising state practices. The last three are really about trying to bring all of the interested parties together to identify strategies that can improve the health of children with Medicaid.
[Roberta Baskin] So what was CMS's response? Or a better question, what has the Center done to take action since OIG issued the report?
[Ann Maxwell] You know, CMS agreed with all of our recommendations and said that it was starting efforts, in collaboration with states and national experts, to improve the services. In December 2010, CMS started a national EPSDT improvement workgroup which was tasked with making recommendations on how to improve data collection. Finally, CMS said that it planned to collect promising practices from states and post them on their website.
[Roberta Baskin] Thank you, Ann Maxwell, Regional Inspector General for the Office of Evaluation and Inspections, for sharing this important work on children's preventive services in Medicaid.
[Ann Maxwell] Thank you, Roberta.
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