Utilization of Preventive Services among Medicaid-Eligible Children

OBJECTIVE: State-administered Medicaid programs are federally mandated to cover free clinical preventive services for Medicaid-eligible enrollees from birth to age 21, under the umbrella of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. While the national target EPSDT participation rate (at least one well-child visit per year) is 80% of eligible children, Arkansas' official EPSDT participation rate has been the lowest in the U.S. for several years (around 25%). The objective of this paper was to use Medicaid enrollment and claims data to describe patterns in the utilization of EPSDT services in Arkansas in 2001 by age, gender, race/ethnicity, and geographic region. METHODOLOGY: This study employed a longitudinal observational design. This study used the 2001 Medicaid Analytic eXtract (MAX) files for Arkansas obtained from Centers for Medicare and Medicaid Services (CMS), including enrollment data and claims data for all enrollees under age 21. Medicaid-eligible children enrolled in the ARKids A program in Arkansas were observed during the 12 months of calendar year 2001, through Medicaid enrollment and claims data files. Individual-level data were used to calculate aggregate EPSDT screening rates for the overall population, for demographic subgroups, and for geographic regions to examine patterns in utilization. EPSDT procedure billing codes were used to measure the utilization of well-child visits. EPSDT ratios were calculated based on the CMS formula (which adjusts for age and the recommended periodicity schedule) overall and by gender, race/ethnicity, and geographic region. FINDINGS: EPSDT rates varied greatly across age groups, as expected, being highest for 1-2 year-olds, less than 1 year old, and 3-5 year-olds, with very low rates for teenagers. There was very little difference in screening rates by gender, both overall and within age groups. The total screening rate was virtually the same for all racial/ethnic groups except for Asian/Pacific Islanders, who had a higher rate. However, age-specific rates varied somewhat by race/ethnicity. Hispanic children under age 3 and Native American children under 1 year old had relatively lower screening rates. Geographic variation in EPSDT rates by county and region are presented graphically in maps. CONCLUSION: By tracing patterns in EPSDT utilization, this study helps to identify areas where increased outreach efforts to families and health care providers are needed. The findings of this project provide useful information that Arkansas and other states can use to target strategies for increasing EPSDT rates.