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 for Executive Action
|Centers for Medicare and Medicaid Services||1. 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.|
|Centers for Medicare and Medicaid Services||2. 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.|