Medicaid Preventive Services: Concerted Efforts Needed to Ensure Beneficiaries Receive Services
Highlights
Medicaid, a federal-state program that finances health care for certain low-income populations, can play a critical role in the provision of preventive services, which help prevent, diagnose, and manage health conditions. GAO examined available data to assess (1) the extent to which Medicaid children and adults have certain health conditions and receive certain preventive services, (2) for Medicaid children, state monitoring and promotion of the provision of preventive services, (3) for Medicaid adults, state coverage of preventive services, and (4) federal oversight by the Centers for Medicare & Medicaid Services (CMS). GAO analyzed data from nationally representative surveys: the National Health and Nutrition Examination Survey (NHANES), which includes physical examinations of participants, and the Medical Expenditure Panel Survey (MEPS). GAO also surveyed state Medicaid directors and interviewed federal officials.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Medicare & Medicaid Services | To improve the provision of preventive services to the Medicaid population, the Administrator of CMS should ensure that state Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) programs are regularly reviewed to identify gaps in provision of EPSDT services to children and to identify needed improvements. |
CMS agreed with our recommendation and has taken several actions aimed at improving children's access to preventive services. In December 2010, CMS formed a National EPSDT Improvement Workgroup which has generated options for improving service delivery, reducing the reporting burden for states, and improving CMS oversight of state performance. As of June 2013, CMS was considering which options to pursue. In 2011, CMS engaged a contractor to conduct in-depth analyses of EPSDT in nine states, conduct an EPSDT literature review, and undertake a 50-state environmental scan of available information on a variety of EPSDT topics. This contract is ongoing and has an estimated completion date of December 2015. In addition, CMS has issued two Informational Bulletins related to EPSDT services, one on prevention and early identification of mental health and substance use conditions in March 2013 and the other on improving access to dental services in April 2013.
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| Centers for Medicare & Medicaid Services | To improve the provision of preventive services to the Medicaid population, the Administrator of CMS should expedite current efforts to provide policy guidance on coverage of obesity-related services for Medicaid children, and consider the need to provide similar guidance regarding coverage of obesity screening and counseling, and other recommended preventive services, for adults. |
Congress has acted on GAO's recommendation to the Centers for Medicare & Medicaid Services within the Department of Health and Human Services (HHS) to improve guidance to states on coverage under the Medicaid program for obesity-related services. Specifically, the Patient Protection and Affordable Care Act, enacted on March 23, 2010, requires the Secretary of HHS to provide guidance and relevant information to states and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. The law also requires that each state design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services, with the goal of reducing incidences of obesity. In addition, not later than January 1, 2011, and every 3 years thereafter through January 1, 2017, the Secretary of Health and Human Services is required to report to Congress on the status and effectiveness of these efforts. HHS submitted its first report to Congress in 2010.
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