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Report: Kids on Medicaid Not Getting Care

By Laura Meckler
Originally published by The Associated Press, Aug. 13, 2001

WASHINGTON (AP) — Studies suggest that millions of poor children in Medicaid are not getting preventive health care services they have coming, an audit said Monday.

The federal agency that runs Medicaid has failed to increase use of these services or to improve the collection of data, the General Accounting Office, Congress’ investigative arm, said in a report released Monday.

Reliable national data are unavailable because states have failed to report required information to the federal government, the GAO said. But small studies that have been conducted by the GAO and other investigators suggest that only a fraction of the 21 million poor children served by Medicaid are receiving these health services.

“More than a decade ago, the Congress passed legislative changes to help ensure that millions of low-income children under Medicaid have access to important health screening and treatment services,” the report said. “This safety net, however, cannot be considered fully in place unless there are assurances that the covered health care services are actually provided.”

Medicaid, the government-funded health insurance program for the poor, pays for a variety of preventive and treatment services, including vision care, dental care and hearing services, through the Early and Periodic Screening, Diagnostic and Treatment program.

A 1999 GAO study found that just 19 percent of children ages 1 to 5 in Medicaid had been screened for lead poisoning, which poses a significant risk for poor kids. Only 21 percent of Medicaid children ages 2 to 5 and 36 percent of those ages 6 to 18 had seen a dentist in the previous year, another recent GAO study found.

Similarly, a 1997 report by the inspector general at the Department of Health and Human Services estimated that only 28 percent of children in Medicaid managed care plans were getting all the screenings offered through Medicaid and that 60 percent received none at all.

A handful of studies in states have found similarly low rates.

GAO pointed to a variety of explanations. In some cases, there aren’t enough doctors or dentists available to serve the kids enrolled. Sometimes, families don’t know these services are available, or do not realize that these services are important. Also, low-income parents may have trouble getting time off or finding transportation to get to the doctor.

In recent months, the report said, the federal government has focused on trying to improve access to services and data collection. But it’s too soon to tell if that will be effective, GAO said. Some states are also working on their own to improve their programs.

Rep. Henry Waxman, D-Calif., who requested the report, said in a statement that the department must do more to prod states into action. “I am dismayed that the federal government knows all of these problems and does so little about it,” he said.

National data on the use of these services are not timely or complete. For example, GAO said, states were required to report on 1999 services by April 2000. But as of January 2001, 15 states had submitted no report and another 15 had failed to complete deficient reports.

Part of the problem is that most kids in Medicaid are now served by managed care plans, which are paid a flat fee per child, rather than a fee for each medical service provided. That makes it much harder to track what services have been delivered.