Instances of child abuse or neglect were not reported to child protective services in 13% of cases, according to an analysis of Medicaid data released Tuesday by HHS' Office of Inspector General.
The agency watchdog said Medicaid data could be used to spot child abuse or neglect among Medicaid beneficiaries, even if those events weren't reported to child protective service agencies or law enforcement. OIG's report recommended that CMS issue guidance to states about using Medicaid data to "help identify incidents of potential child abuse or neglect" and ensure compliance with state reporting requirements.
CMS disagreed with OIG's recommendation, saying that it's not the agency's responsibility because most of the potential cases occurred in a home or public place, not a healthcare facility. The agency already requires healthcare facilities and practitioners to follow state laws concerning abuse and neglect and states are responsible for making sure providers follow their laws, CMS Administrator Seema Verma said in the agency's response to OIG. She added that states have access to Medicaid data, so the agency doesn't need to act.
But OIG stood by its recommendation, arguing that "the places where these beneficiaries were treated fall under CMS's jurisdiction. Moreover, the treating health professionals who are being paid with Medicaid funds also fall under CMS jurisdiction."
"CMS' failure to issue guidance ... represents a missed opportunity to protect Medicaid beneficiaries," OIG said in its report.
According to the Kaiser Family Foundation, nearly 40% of children are covered by Medicaid and CHIP.
HHS' watchdog and CMS also disagreed about whether Medicaid data is timely enough to address child abuse or neglect since claims data takes weeks to process.
"Claims and encounter data can be lagged and transformed as they move from the provider level, to health plans, to the state, then to CMS. With this lag and these transformations, the data may not be current," Verma wrote.
Still, OIG thinks the data would help uncover potential child abuse or neglect since states process more than half of claims in 30 days or less and 85% of claims within three months.
Given that child abuse or neglect episodes often represent patterns of behavior rather than isolated incidents, states could likely use Medicaid claims information to uncover children suffering from abuse or neglect.
But "it is unclear whether analyzing claims data will improve outcomes as the OIG did not include in their review an analysis to determine whether or not providers were in compliance with state reporting requirements," Verma wrote.
CMS agreed with OIG's recommendation to review "federal requirements to report suspected child abuse and neglect of Medicaid beneficiaries to determine whether CMS should strengthen those requirements or seek additional authorities to provide oversight."
OIG looked at nearly 32,000 Medicaid claims from 2017 involving injuries that could have been caused by child abuse or neglect, finding that 29,260 children were potential victims. The data stemmed from emergency department services claims that contained one of 13 diagnosis codes that could indicate possible sexual, physical or psychological abuse in children.
More than 200 other diagnostic codes could signal abuse or neglect, the agency said.