Coverage of screening and necessary treatment for children is one of these requirements. Limited Available Data Indicate Many Children Do Not Receive EPSDT Services

Despite statutory reporting requirements, reliable national data are not available on the extent to which children in Medicaid are receiving EPSDT services. Some Studies Show Screening Rates Are Low

While HCFA’s data cannot present a reliable and comprehensive picture of the extent to which children in Medicaid receive EPSDT services, other studies indicate that many of these children are not receiving such services. Several advocacy groups we interviewed echoed concerns that states and managed care plans do not adequately inform beneficiaries about the broad scope of EPSDT services or about beneficiary appeal rights. Ensuring Service Delivery

States have also put into action a number of initiatives to help ensure that managed care plans and health providers deliver screening and treatment services to children enrolled in Medicaid. For example, to encourage Medicaid beneficiaries, including those in managed care, to take advantage of preventive care, Florida mails reminder letters to families when their children are due for EPSDT screens. They have also identified needed actions to improve children’s access to EPSDT care. Recommendations for Executive Action

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, we recommend that the Administrator of CMS:   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 the EPSDT goal of providing health services to children in Medicaid; and   develop a mechanism for sharing information among states on successful state, plan, and provider practices for reaching children in Medicaid.
Why GAO Did This Study

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.

What GAO Found

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.