Medicaid and Children's Health Insurance Program enrollees are not getting the behavioral and medical care they need, according to new CMS data on the quality of care in those federal programs.
The Affordable Care Act requires the HHS secretary to establish healthcare quality measurement programs for adults and children to obtain standardized data across state Medicaid and CHIP programs. The legislation, however, established it as a voluntary reporting program, allowing state Medicaid and CHIP agencies to decide whether they participate. As a result, the CMS findings on adults in Medicaid (PDF) are based on responses from 34 states, while the CHIP findings (PDF) are based on responses from 37 states.
For adults, a chief red flag is access to behavioral health services. States report on two measures of behavioral healthcare—follow-up after hospitalization for mental illness and medication management.
Follow-up care after hospitalization for mental illness helps improve health outcomes and prevent readmissions in the days following discharge from inpatient mental health treatment, the CMS said.
In fiscal 2014, 30 states reported a median rate of 37% for follow-up visits within seven days of discharge and 57% for follow-up visits within 30 days of discharge.
When individuals are first diagnosed with major depression, it's common to prescribe medication either alone or in combination with psychotherapy. An initial 12-week course of treatment is recommended and doctors meanwhile observe whether it's effective. Continued treatment for six months is recommended to prevent relapse.
Among the 31 states reporting the antidepressant medication management measure for 2014, the median rates were 47% of Medicaid enrollees who were treated with antidepressant medication for 12 weeks and 31% who were treated with medication for six months.
“These results suggest that states have substantial room for improvement on the two behavioral health care measures, and suggest there is a need for enhanced integration of physical and behavioral health care and more coordination across multiple settings of care,” the CMS said.
While the CMS doesn't reference it, access to behavioral health is low across the board, on or off federal programs, as providers tend to not accept insurance.
Responding states had better care metrics when it came to the treatment of chronic physical ailments. For instance, states measure whether Medicaid enrollees get routine monitoring for diabetes care.
Among the 34 states reporting on the measure, a median of 80% of Medicaid enrollees with diabetes got appropriate testing, the CMS said.
In CHIP, the CMS highlighted the need to improve the use of preventive services by young children and adolescents, dental and oral healthcare, coordination of care for children with behavioral health needs, and care of acute and chronic conditions.
For instance, despite high rates (in the 90% plus range) of overall primary-care access, the proportion of children receiving a well-child visit remained below the recommended guidelines. They ranged from a median of 44% for adolescents ages 12 to 21 to a median of 67% for children ages 3 to 6.
The American Academy of Pediatrics recommends nine well-child visits in the first 15 months of life and annual well-child visits for children ages 3 and older.
Among children and adolescents ages 5 to 20 with persistent asthma, the most common chronic childhood condition, the median percentage that remained on an asthma controller medication for at least 75% of their treatment period was just 31%.
“The (asthma treatment) findings suggest substantial room for improvement among states,” the CMS said. However, the agency did not provide any recommendations on how to improve participation in any of the lacking services.
