MIAMI — Almost three-quarters of children on Medicaid in nine states are not getting all of their legally required medical, vision and hearing examinations, including immunizations, according to a new government study.
The study, conducted by the U.S. Department of Health and Human Services inspector general, estimated that 2.7 million of the 3.8 million children in those states — or 76 percent — did not receive one or more of the medical, vision or hearing screenings during 2007, the year studied. The studied states are Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, Texas, Vermont and West Virginia.
Doctors say regular checkups are especially important for low-income children who are at higher risk for chronic problems including obesity, depression and poor cognitive development.
Missing checkups means problems aren't spotted early and increases the chance they will develop into something more significant, said Dr. Louis St. Petery, a Florida pediatric cardiologist.
"Checkups aren't just made up," said St. Petery, who is part of a class-action lawsuit alleging Florida is violating federal Medicaid requirements by providing inadequate medical care for children. "They are essential."
Forty-one percent of children did not receive any required medical screenings. More than half did not receive any required vision or hearing screenings, according to the study.
The federal government has five requirements for medical screenings in children under 21: a comprehensive health and developmental history; an unclothed physical examination; immunizations; lab tests; and health education.
Nearly 60 percent of children who did get a medical screening were lacking at least one of the five requirements. Lab tests were most commonly left out.
State officials say much of the problem is caused by parents skipping appointments. Child advocates say many families have trouble taking time off from work for frequent appointments and struggle to find doctors who accept Medicaid because of low reimbursement rates. The study did not address reimbursement rates.
The study also found a disconnect between outreach efforts and the number of children receiving exams.
"In some states (outreach) was a set of brochures," said John Bouman, president of the Sargeant Shriver National Center on Poverty Law in Chicago. "That isn't adequate. You have to interact with people. You have to match them up with doctors."
Officials in each state said they had spent money on public outreach and media campaigns to promote the importance of health screenings, but the study did not specify the amount.
"I think Florida is doing a miserable job in outreach. That's why there's more than 400,000 children in Florida who are uninsured but are Medicaid eligible," said St. Petery, who is executive vice president for the Florida chapter of the American Academy of Pediatrics.
Florida's Agency for Health Care Administration declined comment.
Health experts say administrative red tape keeps doctors from treating children. State agencies frequently enroll children in different Medicaid plans without notifying their parents, so children show up for a checkup only to find their insurance has been 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 these services, so I intend to explore new ideas to help educate parents and 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 dentists and 25 percent for doctors after a class-action lawsuit similar to Florida's lasted more than a decade. The state spent $707 million on the rate increase and outreach efforts to improve access for the 2008-09 fiscal year, said Geoff Wool, spokesman for Texas Health and Human Services Commission. The participation rate for Texas children receiving at least one screening increased from 60 percent in 2008 to 64 percent in 2009.
Since 2007, Illinois has made an aggressive effort to link children with doctors by creating medical homes for them. The state now gives incentives to doctors who provide a full menu of screenings.
Preliminary 2009 data shows a 20 percent increase in the number of Illinois children getting screenings with a primary care doctor since the study in 2007, according to the Illinois Department of Healthcare and Family Services.
The study recommended the Centers for Medicare and Medicaid Services work with states to find incentives to increase doctor participation and improve outreach efforts to families.
Requiring states to report hearing and vision screenings to CMS was also recommended.