“We end up with kids who are sicker, with more long-term, serious medical issues that are more expensive to treat,” said Jennifer Clarke, executive director of the Public-Interest Law Center of Philadelphia.
Some experts say that state officials—not the federal government—bear most of the responsibility for low screening rates because they administer Medicaid, the state-federal program for the poor. They say states need to step up oversight over the private Medicaid health plans that many contract with to cover children in the program.
“The federal government is working hard on this, but the only power they have over states is to take away their funding and that is highly unlikely,” said Jane Perkins, legal director of the National Health Law Program.
Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis, and Treatment program, or EPSDT, in 1967 so that children would get age-appropriate diagnostic tests, including for vision and hearing, preventive services such as immunizations and treatments. About 32 million children on Medicaid were eligible for the benefit in 2013.
The preventive-care program is more generous than those offered by the Children’s Health Insurance Program (CHIP) or private health insurers because it guarantees coverage not just for a wide range of tests, but also the treatments to address health problems. Most states follow the guidelines of the American Academy of Pediatrics, which calls for 13 preventive visits in first three years of life, followed by mostly annual visits until age 21.
Boston pediatrician Michael McManus, a member of the academy’s state government-affairs committee, said he is saddened by the fact that more than a third of children on Medicaid are not getting at least one regular preventive exam. “We have a lot of work to do,” he said.
Low participation rates have plagued the program for years, according to previous reports by the inspector general’s office and the U.S. Government Accountability Office.
A 2010 OIG report found that 76 percent of children in nine states did not receive all required medical, vision, and hearing screenings, 41 percent of children nationwide did not receive any of the screenings, and more than half did not receive any vision or hearing screenings. All states are required to provide the benefit.
The latest OIG report praised the U.S. Centers for Medicare and Medicaid Services for working to increase screening rates, such as by distributing guides that enable states and providers to share their best ideas. The guides show, for instance, how some states used websites to educate providers and parents. Some states such as New York require Medicaid health plans to educate members about the benefit and what it covers. Neighborhood Health Plan of Rhode Island boosted adolescent screening rates by 40 percent by offering gift certificates for pizza and movie tickets, according to a 2014 CMS report.