On April 5, the U.S. Government Accountability Office (GAO) released a report examining children’s care coordination under Medicaid and the Children’s Health Insurance Program (CHIP).  The report also examines the extent to which mandatory state reports to the Centers for Medicare & Medicaid Services (CMS) reflect the provision of services to children enrolled in those health programs.  Using data from two nationally representative 2007 surveys, the GAO notes that 37 percent of children enrolled in Medicaid and CHIP failed to receive needed care coordination.  In addition, the authors highlight that 12 percent of children in the two health programs had difficulty accessing needed care, tests, or treatments.  The GAO posits that states’ annual reports provide an incomplete assessment of children’s coverage because of reporting errors, missing information, and lack of detail.  The GAO proposes improvements to the state reporting process, particularly designed to differentiate between managed care and fee-for-service (FFS) care.

From the report:

Medicaid and the Children’s Health Insurance Program (CHIP)—two joint federal-state health care programs for low-income families and children—play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have health care conditions that could warrant care from primary care or specialist providers. At the same time, a significant number of children in Medicaid and CHIP may not be receiving basic preventive care, which these programs generally cover. For example, we reported in 2009 that, on the basis of parents’ reports in national surveys, about 40 percent of children in Medicaid and CHIP had not had a well-child checkup over a 2-year period.

Full Report: Medicaid and CHIP: Reports for Monitoring Children’s Health Care Services Need Improvement (PDF | 1.21 MB)

U.S. Government Accountability Office. (2011). Medicaid and CHIP: reports for monitoring children's health care services needs improvements.