August 2nd, 2013
The recent article in the July edition of Health Affairs titled “Existing Medicaid Beneficiaries Left Off the Affordable Care Act’s Prevention Bandwagon,” by Sara Wilensky and Elizabeth Gray, overlooked several important steps that are underway to assure that all Medicaid beneficiaries receive preventive care.
Medicaid has historically played an important and leading role in ensuring people have access to the preventive services that have proven to be successful in reducing disease and improving health. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is key to ensuring children and adolescents receive the vital preventive, dental, vision, mental health, and other services they need to grow up healthy. This service is available to all children under 21 who are enrolled in Medicaid. EPSDT, in partnership with the Vaccines for Children program, also provides children with appropriate and necessary immunizations.
The Affordable Care Act has allowed greater access to preventive benefits for even more Medicaid beneficiaries. First, beneficiaries who enroll as part of the Medicaid coverage expansion will have full coverage of preventive services without cost sharing, consistent with the benefit provided to people who buy private insurance on the Marketplace. Another part of the law already in effect provides states with enhanced Federal funding to provide comprehensive coverage of preventive services that are recommended by the United States Preventive Services Task Force (USPSTF), as well as recommended vaccines, without cost sharing.
The law also makes certain tobacco cessation services a required benefit for all Medicaid beneficiaries starting in 2014. Pregnant women can already access comprehensive tobacco cessation services without cost sharing thanks to the Affordable Care Act. And in June of 2011 the Centers for Medicare and Medicaid Services made clear that federal Medicaid funding is available to reimburse community-based quitlines.
CMS has also been working closely with states to improve the way health care is delivered for Medicaid beneficiaries with a strong emphasis on innovation and coordination of preventive care. For instance, Oregon, which has recently begun a demonstration that focuses on the work of community health workers, established strong prevention milestones that they must meet as part of the project. The Medicaid program in Massachusetts is emphasizing asthma prevention. And Medicaid managed care plans across the country are focusing on diabetes prevention through the Diabetes Prevention Project.
Additionally, CMS is working to streamline federal regulations to remove barriers to proven prevention strategies. A variety of providers can strengthen preventive efforts in their community. Past payment barriers have made these efforts difficult. Under a regulation released this summer, Medicaid will now reimburse for preventive services administered by a health worker who has been recommended by a licensed health professional. This will increase access to preventive care throughout the community.
Prevention is critical to improving care and lowering costs in our country’s health care system and we appreciate the interest in studying the experiences of Medicaid beneficiaries accessing preventive services. CMS is working hard with states and providers to increase access to comprehensive preventive care for all Medicaid beneficiaries.Email This Post Print This Post
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