Medicaid

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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