Today, the Centers for Medicare & Medicaid Services (CMS) released preliminary Medicaid and Children’s Health Insurance Program (CHIP) data revealing that, during the coronavirus disease 2019 (COVID-19) public health emergency (PHE), rates for vaccinations, primary, and preventive services among children in Medicaid and CHIP have steeply declined. This decline may have significant impacts on long-term health outcomes for children, as Medicaid and CHIP cover nearly 40 million children, including three quarters of children living in poverty and many with special health care needs that require health services. Further, as many schools remain closed for in-person instruction, many of the key services children receive may be delayed, such as child screens and vaccinations prior to the start of the school year or in-school services such as speech therapy, physical therapy, and occupational therapy. Because preventative and routine healthcare is crucial to ensuring that children stay healthy, CMS is releasing this preliminary data to raise awareness of the vital services Medicaid and CHIP provides, and calling on stakeholders to take action to make services more readily available so that we can begin closing the gap in care for children.
A recent CMS data analysis reveals that, compared to the same time period in 2019, there was a significant decline in critical primary and time-sensitive preventative services for children between March and May. Specifically, during this timeframe, there were 22 percent fewer (1.7 million) vaccinations received by beneficiaries up to age 2, 44 percent fewer (3.2 million) child screening services that assess physical and cognitive development and can provide early detection of autism and developmental delay, among other conditions, even after accounting for the increased use of telehealth, and 69 percent fewer (7.6 million) dental services. Although this analysis only focuses on data through May 2020 because of the natural lag between when a service occurs and when CMS receives data, the precipitous decline in services remains a cause for concern. Not only must state and local agencies, providers, schools and other key stakeholders work on returning to prior year treatment levels, they must also strive to treat the millions of children who have already missed important medical services. This is essential, as missing these services can have long-term negative impacts on children’s health outcomes.
“As a mother, I have witnessed first-hand how important early and regular access to screening and medical care is for children’s development,” says CMS Administrator Seema Verma. “The absence of these vital health care services may have lifelong consequences for these vulnerable children, and I call on states, pediatric providers, families, and schools to ensure children catch-up on overdue medical, behavioral health and dental appointments as well as childhood immunizations.”
Since the national emergency was declared in March 2020, CMS has taken swift action nationwide to aggressively respond to COVID-19 and to work with our state partners to provide Medicaid and CHIP programs the flexibilities they need to combat COVID-19 locally. CMS has collaborated closely with states to quickly provide the flexibilities needed to respond to the PHE, approving more than 500 state requests for waivers, state plan amendments, and other flexibilities during the PHE. CMS has also encouraged states to consider telehealth options as a flexibility in combatting the COVID-19 pandemic and increasing access to care. Preliminary data shows that while service delivery via telehealth for children has increased dramatically, it is still not enough to offset this decline in care for vulnerable children. Further, although telehealth remains an important part of care delivery for children, some services, such as vaccinations, cannot be provided through this vehicle, which contributes to the current gap in their healthcare.
While national data show that vaccination rates are increasing, the number of vaccines that have been administered so far this year have yet to make up for the large decline earlier in the year. To ensure that children catch up on their missed vaccines we need vaccination rates to not only approach those of 2019, but to be much higher, in order to mitigate the 22 percent dip during the early part of the COVID-19 PHE. This has not begun to happen, and increases the risk of transmission of vaccine-preventable illnesses, such as measles, mumps, and Haemophilus influenza. The potential for increased outbreaks of infectious disease due to decreased vaccinations is real, and can result in decreased school attendance, decreased learning, and increased childhood illness in general.
Although the start of the school season will be different for children as many begin their education in a virtual manner, the critical need for children to receive preventative and routine healthcare persists. It is important for schools and families to catch up on well-child visits and ensure that children are up-to-date on their immunizations.
The data released today can be found here:https://www.medicaid.gov/resources-for-states/downloads/medicaid-chip-beneficiaries-18-under-COVID-19-snapshot-data.pdf
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