A Michigan plan to extend Medicaid coverage to thousands of children, young adults and expectant mothers might become the state's most aggressive tool in tracking the long-term consequences of lead poisoning.
Gov. Rick Snyder has asked for expanded Medicaid coverage for nearly 15,000 Flint residents who are either pregnant women or under the age of 21. He also asked to expand the income eligibility for the program to up to 400% of the federal poverty level.
The coverage will provide beneficiaries with early and periodic screening and diagnostic and treatment, or EPSDT, benefits that cover a range of conditions and illnesses.
There is no equivalent benefit in private coverage, according to Steve Fitton, who was Michigan's Medicaid director until June 2015. Fitton now is a principal at Health Management Associates.
According to the CMS, the goal of EPSDT is to ensure that children get the healthcare they need when they need it. The benefits are offered through different stages in the child's life and states are required to report annually to the CMS certain data about their delivery of services under the EPSDT benefit.
This might provide health officials the information they need to determine how the lead poisoning affected the Flint population.
And access to screenings is not likely to be a problem, even though the state has expanded Medicaid coverage twice this year, adding a burden to the state's providers.
Last April, the program began to enroll individuals with incomes up to 138% of the federal poverty level and more than 600,000 people signed up.
Nationally, providers have been reluctant to accept Medicaid beneficiaries because of the program's low reimbursement rate, but in Michigan, that hasn't been the case.
An analysis released last summer found that appointment availability for new Medicaid patients increased from 49% to 55% before and after the implementation of Medicaid expansion. Wait times for new Medicaid did not significantly increase before and after expansion, with the average being between one to two weeks.
The research (PDF), released by the Institute for Healthcare Policy and Innovation at the University Michigan, was co-authored by Dr. Renuka Tipirneni, a clinical lecturer in the university's department of internal medicine.
She has continued to monitor access to care for Medicaid beneficiaries and believes that newly eligible enrollees in Flint will be able to get the care they need.
“Medicaid offers a more robust benefit package and has cost-sharing that can be significantly less,” said Jennifer Eisner, a spokeswoman for the Michigan Health Department.
Providers have assured concerned lawmakers that they would be willing to take on additional Medicaid patients as they had seen too many sad stories of what happens when someone doesn't have coverage, and treatable ailments became disabling or fatal. That commitment remains and will continue during a second expansion according to Dr. Kim Yu, president of the Michigan Academy of Family Physicians, who practices near Flint in Saginaw, Mich.
“Even though it's lower reimbursement, which creates some practice operating issues, primary-care physicians are dedicated to providing care,” Yu said.
Still, access to behavioral health services may remain as big of a problem as it is throughout the country. There is a shortage generally of such providers, and that is reflected in Michigan, according to Dr. Mona Hanna-Attisha, the pediatrician who fought to expose Flint's lead crisis.
Attisha believes this will be an important problem to address since Flint residents will likely experience some mental health issues.
A centralized source to find providers might also increase access, said Dr. Bobby Mukkamala, a Flint otolaryngologist, and vice chair of the board of directors of the Michigan State Medical Society.
For instance, of the 221 family physicians listed as practicing in Flint area on DocSpot, a website to help consumers choose doctors, only one is listed as accepting Medicaid. Mukkamala says he can think of at least a dozen that do.
The CMS did not respond to a request for comment.