The Use of EPSDT and Other Health Care Services by Children Enrolled in Medicaid: The Impact of OBRA'89

Abstract

To increase the participation of Medicaid children in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program and to improve their health, Congress included several provisions in the Omnibus Budget Reconciliation Act of 1989 (OBRA’89) that addressed problematic program features. The impact of these provisions on children's health service use was investigated in a study funded by the Health Care Financing Administration. After conducting site visits to four states, the authors analyzed claims data for the children residing there and found evidence that, in 1992, these states placed a higher priority on improving the effectiveness of EPSDT than they did before 1989. The states’ efforts to expand the EPSDT provider base and to enhance outreach and service provision were either directly or indirectly inspired by OBRA’89. The authors also found evidence of a significant impact on provider participation and caseloads and on children’s use of both preventive care and diagnostic and treatment services. However, the effects were modest in comparison to the size of the progress that is required.

Associations Between Maternal Age and Infant Health Outcomes Among Medicaid-Insured Infants in South Carolina: Mediating Effects of Socioeconomic Factors

“…[28][29][30] The American Academy of Pediatrics (AAP) recommends 6 EPSDT visits in the first year of life and 3 in the second year. 31,32 These recommendations have been endorsed by the South Carolina Department of Health and Human Services for infants who are enrolled in Medicaid. The number of infant EPSDT visits represents the combined number of visits for immunizations and/or screening services.…”

Effects of Primary Care Case Management (PCCM) on Medicaid Children in Alabama and Georgia: Provider Availability and Race/Ethnicity

“…Even while PCCM is intended to reduce unnecessary utilization, and perhaps primary care, it is not intended to reduce preventive care among these low-income children as these services are generally underused (Gavin et al 1998). Our analysis indicates, however, that PCCM reduced the odds of receiving preventive care both through its direct effect and through any related changes in provider availability in the urban areas of Alabama for white and black non-Hispanic children and in Georgia, only for urban black children.…”

“…Earlier studies of PCCM found clear effects in terms of the use of the emergency room (ER), prescription drugs, and hospital services (Hurley, Freund, and Paul 1993) but less specific findings with regard to preventive care (Hurley, Freund, and Paul 1993;Gavin et al 1998;Zuckerman, Brennan, and Yemane 2002). By and large, these studies did not address possible differential effects of PCCM on children from different racial/ethnic backgrounds on utilization.…”

“…PCCM effects on children's utilization include some positive effects for primary care (Schoenman, Evans, and Schur 1997;Zuckerman, Brennan, and Yemane 2002) but less that is specific to preventive care (Hurley, Freund, and Paul 1993;Gavin et al 1998;Zuckerman, Brennan, and Yemane 2002).…”

Well child care in the United States: racial differences in compliance with guidelines

“…In the intervening years, programs have been aimed at improving preventive care of lower income children. 69,70 A Centers for Disease Control and Prevention (CDC) study of children born from 1993 to 1995 showed improved immunization levels, in spite of an increased number of required immunizations, but there were continuing racial disparities among the poor. 71 Improved immunization rates are no guarantee of improved preventive care rates unless immunization is consistently provided in the context of a preventive care visit.…”