A report by the Inspector General (IG) for HHS indicates that children in foster care are not receiving required health screenings.  The report comes after a November 2014 IG report that found that there were significant shortfalls in health screening for all children enrolled in Medicaid.

The new report, Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings, examined four states, California, Illinois, New York and Texas representing 31 percent of the children in foster care.  The IG found that nearly a third of the children did not receive at least one required screening and that one quarter received a screening late.  California, New York and Illinois require a screening with 24 hours (with Illinois requiring a second comprehensive screening within 21 days) and Texas requires an initial screening with 30 days.

Under current federal requirements states must have a schedule for initial and follow-up screens, address how identified needs will be monitored and followed up, address how health records will be maintained and updated, take steps to ensure a continuity of health care and oversight of medication, indicate how the state consults and involves health experts, and requires states to provide special assistance and information for youth aging out of foster care.

The IG recommended that HHS include a review of state screenings through the Child and Family Services Review (CFSRs), and that HHS identify and disseminate strategies to identify and address barriers to the required screenings.  In response the Administration on Children and Families indicated they would consider the first recommendation and review the second.

The November IG report CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services  dealing with the effectiveness of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) noted that health screenings have increased (nationally) from 56 percent in 2006 to 63 percent in 2013, but also found that both targets are still well below the HHS required goal of 80 percent EPSDT screenings. In nine states 76 percent of children did not receive a single screening.  Overall 32 million children are eligible for the mandated screenings.

The EPSDT requirement is intended as a comprehensive and preventive health care service for children (to age 21) who are enrolled in Medicaid. States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. EPSDT is made up of the following screening, diagnostic, and treatment services.  The required screenings are in five areas:

 Comprehensive health and developmental history

Comprehensive unclothed physical exam

Appropriate immunizations (according to the Advisory Committee on Immunization Practices)

Laboratory tests (including lead toxicity screening)

Health Education (anticipatory guidance including child development, healthy lifestyles, and accident and disease prevention)Required services include vision, dental, hearing and “other necessary health care services.” These necessary services are all those that are coverable under the federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state’s Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.