Almost three-quarters of children on Medicaid innine states are not getting all of their legally required medical,vision and hearing examinations, including immunizations, accordingto a new government study.
The study, conducted by the U.S. Department of Health and HumanServices inspector general, estimated that 2.7 million of the 3.8million children in those states, or 76 percent, did not receiveone or more of the medical, vision or hearing screenings during2007, the year studied. The studied states are Arkansas, Florida,
Idaho, Illinois, Missouri, North Carolina, Texas, Vermont, and WestVirginia.
Doctors say regular checkups are especially important forlow-income children who are at higher risk for chronic problemsincluding obesity, depression and poor cognitive development.
Missing checkups means problems aren't spotted early andincreases the chance they will develop into something moresignificant, said Dr. Louis St. Petery, a Florida pediatriccardiologist.
"Checkups aren't just made up," said St. Petery, who is partof a class-action lawsuit alleging Florida is violating federalMedicaid requirements by providing inadequate medical care forchildren. "They are essential."
Forty-one percent of children did not receive any requiredmedical screenings. More than half did not receive any requiredvision or hearing screenings, according to the study.
The federal government has five requirements for medicalscreenings in children under 21: a comprehensive health anddevelopmental history; an unclothed physical examination;immunizations; lab tests; and health education.
Nearly 60 percent of children who did get a medical screeningwere lacking at least one of the five requirements. Lab tests weremost commonly left out.
State officials say much of the problem is caused by parentsskipping appointments. Child advocates say many families havetrouble taking time off from work for frequent appointments andstruggle to find doctors who accept Medicaid because of lowreimbursement rates. The study did not address reimbursement rates.
The study also found a disconnect between outreach efforts andthe number of children receiving exams.
"In some states (outreach) was a set of brochures," said JohnBouman, president of the Sargeant Shriver National Center onPoverty Law in Chicago. "That isn't adequate. You have to interactwith people. You have to match them up with doctors."
Officials in each state said they had spent money on publicoutreach and media campaigns to promote the importance of healthscreenings, but the study did not specify the amount.
"I think Florida is doing a miserable job in outreach. That'swhy there's more than 400,000 children in Florida who are uninsuredbut are Medicaid eligible," said St. Petery, who is executive vicepresident for the Florida chapter of the American Academy ofPediatrics.
Florida's Agency for Health Care Administration declinedcomment.
Health experts say administrative red tape keeps doctors fromtreating children. State agencies frequently enroll children indifferent Medicaid plans without notifying their parents, sochildren show up for a checkup only to find their insurance hasbeen switched and the new provider doesn't cover the doctor.Parents are less likely to schedule another appointment after that.
"It's clear there are barriers to helping kids access theseservices so I intend to explore new ideas to help educate parentsand doctors about these benefits," said Sen. Max Baucus, D-Mont.,chairman of the Senate Finance Committee.
Some states have made improvements since the study.
Texas increased reimbursement rates by 50 percent for dentistsand 25 percent for doctors after a class-action lawsuit similar toFlorida's lasted more than a decade. The state spent $707 millionon the rate increase and outreach efforts to improve access for the2008-09 fiscal year, said Geoff Wool, spokesman for Texas Healthand Human Services Commission. The participation rate for Texaschildren receiving at least one screening increased from 60 percentin 2008 to 64 percent in 2009.
Since 2007, Illinois has made an aggressive effort to linkchildren with doctors by creating medical homes for them. The statenow gives incentives to doctors who provide a full menu ofscreenings.
Preliminary 2009 data shows a 20 percent increase in the numberof Illinois children getting screenings with a primary care doctorsince the study in 2007, according to the state's Department ofHealthcare and Family Services.
The study recommended the Centers for Medicare and MedicaidServices work with states to find incentives to increase doctorparticipation and improve outreach efforts to families.
Requiring states to report hearing and vision screenings to CMSwas also recommended.Copyright © 2014, Los Angeles Times