In 2008 Medicaid and the Children’s Health Insurance Programs covered 36 million American children. Given the continuing expansions in coverage and population growth, that number is likely even higher now. The Centers for Medicare and Medicaid Services supposedly keeps tabs of the programs and the quality of services that the recipients get. Congress and others have expressed concern about whether preventive services are being received and whether there is adequate access to and coordination of care, so the Government Accounting Office was asked to report on these concerns. (GAO Report)
The report is meager, relying on survey data from MEPS and the National Survey of Children’s Health and on the programs reports to CMS; reports that GAO characterizes as inadequate and usually incomplete and inaccurate. Based on its limited research, GAO concludes that over a third of the children who needed care coordination didn’t get it, that about one-eighth of those who needed care had access problems, and about a quarter of those who needed a specialist had troubling finding one. GAO also looked at five specific state programs to improve care coordination, but only one, North Carolina, had evaluated the results, finding that its medical home-type effort had saved $190 million in 2009.
The report really does not have any analysis of why there are shortcomings in either receiving services, obtaining access or having care coordinated. The access issue is almost certainly due both to geographic constraints related to where many of the children live and the pathetic reimbursement offered by Medicaid and CHIPs programs, reimbursement that will only get worse as governments must control spending. Unfortunately the report did not look at managed care versus fee-for-service programs; if it had it would likely have found, as has other research, that managed care does a much better job of coordinating care and delivering preventive services than do the FFS programs. And we have made the point before that the government insists on ignoring the obvious reality that many of these children’s parents are extremely irresponsible in most aspects of their lives, including health, and the programs have no incentives or penalties to make them be more responsible or lose coverage. Unfortunately the children pay the health price for their parents’ irresponsibility.