Medicaid:

Stronger Efforts Needed to Ensure Children's Access to Health Screening Services

GAO-01-749, Jul 13, 2001

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The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program calls for states to provide children and adolescents under age 21 with access to comprehensive, periodic evaluations of health, development, and nutritional status, as well as vision, hearing, and dental services. There is concern that state Medicaid programs are not doing an adequate job of screening children for medical conditions or providing treatment for the children who need it. There is also concern about how these services are faring under managed care plans. This report examines (1) the extent to which children in Medicaid are receiving EPSDT services, (2) efforts that selected states are taking to improve delivery of EPSDT services, particularly within managed care, and (3) federal government efforts to ensure that state Medicaid programs provide covered EPSDT services. GAO found that the extent to which children in Medicaid are receiving EPSDT services are not fully known, but the available evidence indicates that many are not receiving these services. A Department of Health and Human Services Office of Inspector General study found that less than one-half of enrolled children in their sample received any EPSDT screens. GAO found that states are taking actions to improve delivery of EPSDT services, particularly within managed care. These actions include linking several state databases, publishing statistics that compare performance, contracting with local health departments to coordinate care for children, and mailing reminder letters to parents. Federal efforts to ensure that children are receiving services have largely focused on changing the state reports so that they can collect reliable information about the extent of the EPSDT screening.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To strengthen the federal role in ensuring the delivery of EPSDT services and to bring greater visibility to ways that states can better serve children in Medicaid, the Administrator of the Centers for Medicare and Medicaid Services (CMS) should work with states to develop criteria and time frames for consistently assessing and improving EPSDT reporting and the provision of services, including requiring that states develop improvement plans as appropriate for achieving EPSDT goal of providing health services to children in Medicaid.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: CMS headquarters is working with its regional offices to conduct oversight, particularly with those states that are underachieving in this area. Regional offices reviewed many of their state EPSDT service delivery and reporting systems within fiscal year 2003 and 2004.

    Recommendation: To strengthen the federal role in ensuring the delivery of EPSDT services and to bring greater visibility to ways that states can better serve children in Medicaid, the Administrator of CMS should develop a mechanism for sharing information among states on successful state, plan, and provider practices for reaching children in Medicaid.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: CMS held a national EPSDT meeting in August 2002, for state EPSDT coordinators and CMS Central Office and Regional Office staff. At the meeting, a draft EPSDT handbook, developed under a CMS contract with the National Association of State Health Policy, was distributed. The meeting was designed to be an information-sharing forum for states to discuss among themselves, and with CMS, various EPSDT issues, including best practices, state successes, and issues that continue to need attention. The Handbook addresses the universal issues that many states continue to have (e.g. data collection) and offers examples of how states have dealt with problems.