Coverage of Preventive Services for Adults in Medicaid

Executive Summary
  1. The survey instrument was developed based on recommendations from the USPSTF related the ACA provision - http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm and the Advisory Committee on Immunization Practices recommendations for adults in 2010 -http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5901a5.htm.

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  2. Eight of these services (see Appendices 8A and 8B) were either recommended by HRSA or under review by USPSTF at the time of the survey following the Institute of Medicine’s (IOM) release of a report commissioned by the US Department of Health and Human Services (HHS) stating that there is a gap in preventive services covered by insurance companies for women. For more information please see Women's Preventive Services Guidelines and Clinical Preventive Services for Women: Closing the Gaps.

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  3. The HRSA women’s preventive services are not required for states to receive the enhanced match, but were included in the survey because they have been recommended as important to fill in gaps in preventive care for women and overlap with many of Medicaid’s benefits categories.

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Introduction
  1. KCMU/Urban Institute estimates based on data from FY 2010 MSIS and CMS-64. MSIS FY 2009 data were used for CO, MO, NC, and WV, but adjusted to 2009 CMS-64.

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  2. KCMU (2013). What Difference Does Medicaid Make? https://www.kff.org/wp-content/uploads/2013/05/8440-what-difference-does-medicaid-make2.pdf

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  3. Preventive Services Covered by Private Health Plans under the Affordable Care Act. Kaiser Family Foundation. https://www.kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans/

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  4. CMS. (2013). http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-12-17.html

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  5. The survey instrument was developed based on recommendations from the USPSTF related the ACA provision - http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm and the Advisory Committee on Immunization Practices recommendations for adults in 2010 - http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5901a5.htm.

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  6. The survey instrument was developed based on recommendations from the USPSTF related the ACA provision - http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm and the Advisory Committee on Immunization Practices recommendations for adults in 2010 -http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5901a5.htm.

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  7. Eight of these services (see Appendices 8A and 8B) were either recommended by HRSA or under review by USPSTF at the time of the survey following the Institute of Medicine’s (IOM) release of a report commissioned by the US Department of Health and Human Services (HHS) stating that there is a gap in preventive services covered by insurance companies for women. For more information please see Women's Preventive Services Guidelines and Clinical Preventive Services for Women: Closing the Gaps.

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Survey Findings
  1. Timothy Westmoreland, Director, Centers for Medicare and Medicaid Services, State Health Official Letter, January 4, 2001, http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho010401.pdf

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  2. CDC. (2013). Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States.

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  3. The survey findings reported here reflect whether a state covers HIV screenings for adults at increased risk for HIV infection and routine HIV screening for adults. For more information HIV screenings – see the following brief: State Medicaid Coverage of Routine HIV Screening. Kaiser Family Foundation, February 2014. https://www.kff.org/hivaids/fact-sheet/state-medicaid-coverage-of-routine-hiv-screening/

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  4. The Role of Medicaid for Adults with Chronic Illnesses. Kaiser Commission on Medicaid and the Uninsured. https://www.kff.org/wp-content/uploads/2013/01/8383.pdf

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  5. Farley, Thomas A. et al. “Deaths Preventable in the U.S. by Improvements in the Use of Clinic Preventive Services.” American Journal of Preventive Medicine, Vol. 38 no. 6, 2010. http://download.journals.elsevierhealth.com/pdfs/journals/0749-3797/PIIS0749379710002072.pdf.

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  6. Maciosek, Michael V. et al. "Greater Use of Preventive Services in U.S. Health Care Could Save Lives at Little or No Cost," Health Affairs, Vol. 29 no. 9, September 2010. http://content.healthaffairs.org/content/29/9/1656.full.pdf.

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  7. Twenty-eight states covered both healthy diet counseling and obesity screening and counseling services; Alaska reported coverage for obesity screening and counseling but not healthy diet counseling. The 7 states that charged cost-sharing for these services were IA, KY, MO, MT, ND, PA, and VA. Additionally, AK reported charging cost-sharing for obesity screening and counseling.

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  8. Cynthia L. Ogden, Margaret D. Caroll, et al. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Journal of the American Medical Association (February 26, 2014,) http://jama.jamanetwork.com/article.aspx?articleid=1832542.

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  9. CDC. 2000. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4916a1.htm

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  10. Guttmacher Institute. (2013). Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy and Infant Care.

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  11. IOM. (2011). Clinical Preventive Services for Women: Closing the Gaps.

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  12. HRSA. (2014). Women's Preventive Services Guidelines.

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  13. Hawaii did not provide a response for screening for gestational diabetes, contraceptive methods and counseling, and well woman visit.

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  14. KCMU, Premiums and Cost-Sharing in Medicaid: A Review of Research Findings, February 2013.

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Appendices
  1. CMS. (2013). http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-13-002.pdf

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  2. The guidance states that the one percentage point increase also applies to the enhanced federal match rate for those newly eligible for Medicaid coverage due to the Medicaid expansion. Since the federal match rate cannot exceed 100 percent, the one percentage point increase will not apply to this match rate until January 1, 2017, when the federal match for the newly eligible will first drop below 100 percent.

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