Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services

Objectives

1. To determine the extent to which children in nine selected States received required Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings.
2. To determine the extent to which children in nine selected States received all of the required components of EPSDT medical screenings.
3. To describe nine selected States’ efforts to increase EPSDT-eligible children’s participation in EPSDT screenings and the completeness of EPSDT medical screenings.

Background

Medicaid provides a comprehensive and preventive child health benefit for children under the age of 21, known as the EPSDT benefit. Services provided under the EPSDT benefit are intended to screen, diagnose, and treat children eligible for EPSDT services at early, regular intervals to avoid or minimize childhood illness. The EPSDT services cover four health-related areas: medical, vision, hearing, and dental. This study focuses on medical, vision, and hearing screenings. Only medical screenings have components specifically required by the statute. Complete medical screenings under the EPSDT benefit must include the following five components: a comprehensive health and developmental history, a comprehensive unclothed physical examination, appropriate immunizations, appropriate laboratory tests, and health education. We reviewed medical records in 9 States for a sample of 345 children enrolled in Medicaid in 2007. We also conducted structured interviews with State Medicaid staff responsible for the EPSDT benefit in nine States.

Findings

Three out of four children did not receive all required medical, vision, and hearing screenings.

In 9 States, 76 percent of children, or 2.7 million children, did not receive 1 or more of the required EPSDT medical, vision, or hearing screenings. Forty-one percent of children did not receive any required medical screenings. In addition, more than half of children did not receive any required vision or hearing screenings.

Nearly 60 percent of children who received EPSDT medical screenings lacked at least one component of a complete medical screening.

Fifty-five percent, or nearly 2 million children in 9 selected States, received medical screenings. Of these 2 million children, 59 percent did not receive all five required components of a medical screening during a 1-year period. Children were missing appropriate laboratory tests most often; 38 percent of children who received medical screenings did not receive this component.

All nine States reported strategies to improve participation in EPSDT screenings and the completeness of EPSDT medical screenings.

Officials from all selected States’ Medicaid agencies identified strategies to increase both the number of children who receive screenings as well as the completeness of medical screenings. Officials from all selected States identified at least one of three main strategies to improve beneficiary participation in EPSDT: direct communication to eligible families, outreach, and incentives. In addition, officials from all selected States reported strategies to increase the number of complete screenings, primarily through education and incentives for providers.

Recommendations

Most children are not fully benefiting from EPSDT’s comprehensive screening services. Two primary factors contributed to this problem. First, children did not receive the correct number of each type of screening. Second, when children received medical screenings, they were often incomplete. These two factors taken together indicate that very few children received the correct number of complete medical screenings and the correct number of vision and hearing screenings. In addition, while all States reported strategies to improve both the number of screenings and the completeness of medical screenings, these strategies do not appear to have the desired effect. The disconnect between States’ efforts to improve the EPSDT program and the low number of children receiving required screenings is difficult to account for, but indicates that additional efforts are required. Therefore, we recommend that CMS:

• require States to report vision and hearing screenings,
• collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings,
• collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and
• identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

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