Many children covered under Medicaid and CHIP needing care coordination and access to care networks had difficulty getting the needed services, according to a report released by the Government Accountability Office.
Further, the report noted that states need to do a better job of reporting the care they provide for children as required under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which requires the GAO to periodically study and report on access to care for children in these programs.
Specifically, the report noted that 2007 data from the National Survey of Children's Health indicated nearly 45 percent of children enrolled in Medicaid and CHIP need care coordination. Of that number, 37 percent did not receive any care coordination. The report also noted children had restricted access to networks of care.
Using data from the same year provided by the Medical Expenditure Panel Survey, the GAO found that children in Medicaid or CHIP were twice as likely to have difficulty accessing networks of care than children enrolled in private health plans (12 percent versus 6 percent, respectively).
"Although some states are expanding initiatives to help improve children's access to care coordination services, almost one-quarter of families with Medicaid and CHIP children who needed specialty care reported problems accessing that care," the report stated. "Monitoring is important for ensuring access to specialty care for Medicaid and CHIP children, including the collection of information on whether needed specialty care services for which children have been referred were received."
The GAO noted, however, that there remain roadblocks to accurately monitoring how well states are doing, both in healthcare services to children and errors in reports filed on their fee-for-service and managed care programs with the Centers for Medicare & Medicaid Services.
In 2008, the GAO found significant reporting problems with reports to CMS regarding Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, which cover preventive and diagnostic treatments including well-child check ups.Twelve state reports contained errors.
[See also: CHIP scorecard reveals uneven care across states; CMS changes PERM procedures for Medicaid and CHIP programs]
"In 10 of these states errors were large enough to result in overstatement of the extent to which children received well-child checkups," said the report. "Both annual reports lack the detail necessary to assess children's access to care by delivery model, that is, the information needed to monitor services provided to children in managed care versus services provided in fee-for-service systems."
In light of the need for accurate information on children's access to service under Medicaid and CHIP, the GAO has recommended that CMS develop plans to review the accuracy and completeness of reports submitted by the states and work with the state reporting agencies to identify improvements in annual reports, "including options for reporting on the receipt of services separately for children in managed care and fee-for-service delivery models."