Medicaid Managed Care: Actions to Improve the Extent to Which Children Receive Medical Screenings and Treatment
Fast Facts
Children covered by Medicaid are entitled to a comprehensive set of screening, diagnostic and treatment services. These services help ensure that children's health conditions are found and treated in a timely manner.
States are responsible for making sure eligible children aged 20 and under receive these services. As of fiscal year 2023, well-child screening rates hadn't yet returned to pre-pandemic levels.
States often contract with managed care plans to deliver Medicaid services. To help increase the use of children's services, plans have offered gift cards, teddy bears, education on the benefits of early screenings, and more.
Highlights
Why This Matters
Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment requirements provide a range of preventive and medically necessary health care services to eligible children. Services include well-child screenings to identify potential medical issues, and treatment to improve or maintain the child’s health. The Centers for Medicare & Medicaid Services (CMS) oversees states’ provision of Medicaid.
GAO Key Takeaways
State Medicaid programs often contract with managed care plans to deliver health care services, including well-child screenings and treatment. In fiscal year 2022, the most recent data available, about 85 percent of the 33 million children covered by Medicaid were enrolled in managed care plans.
Three states we reviewed had programs that withheld a small portion of managed care plans’ funding. The funding was then used to reward plans that improved performance on well-child screening and treatment quality measures. Medicaid officials in Ohio and Washington said their programs were effective tools to encourage plans to improve performance, such as the extent to which eligible children receive well-child screenings. Results from North Carolina are not yet available, but officials said they may add more quality measures.
Selected managed care plans developed incentives for children, their caregivers, and providers to improve the extent to which children receive screenings and treatment. For example, Rhode Island offered children a teddy bear for completing a blood lead screening. Some plans offered providers support with coordinating care. Also, some plans increased payment rates for certain services to encourage improved access to screenings, including behavioral health screenings.
Example of a Medicaid Periodic Well-Child Screening and Identification for Treatment
How GAO Did This Study
We reviewed documentation and interviewed Medicaid officials from a non-generalizable sample of four states with large child Medicaid managed care populations. We also reviewed CMS guidance, and interviewed CMS, two managed care plans per state, and seven stakeholder organizations, including those representing children.
For more information, contact Michelle B. Rosenberg at rosenbergm@gao.gov.