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Medicaid programs vary in coverage of preventive care

Some state Medicaid plans are not required to cover preventive services, such as screening tests for colorectal cancer, high blood cholesterol, HIV infection and diet counseling for adults who are already enrolled in Medicaid, according to a study published in Health Affairs.

Under the Affordable Care Act, most private insurance plans, as well as Medicare and Medicaid, are required to cover preventive services that can ward off cancer, heart disease and other deadly diseases. However, the study, conducted by researchers at the George Washington University School of Public Health and Health Services, found that existing Medicaid beneficiaries are being excluded from this coverage.

The researchers reviewed Medicaid policies in all 50 states and the District of Columbia from June 2012 through November 2012. The initial review looked at all publically available information on coverage of preventive services, and after the first review, the researchers then contacted state Medicaid officials to fill in any missing information about coverage for this population.

They found that most states do not cover all of the preventive services recommended by the U.S. Preventive Services Task Force, an independent panel that looks at preventive care and offers guidelines for health plans and providers. In addition, it was often difficult to discern which services were covered by Medicaid programs based on the vague language used by many programs. 

“The Affordable Care Act guarantees millions of low-income Americans access to mammograms, colonoscopies and other lifesaving preventive services, but that assurance does not extend to people who currently have Medicaid coverage,” Chris Hansen, president of the American Cancer Society Cancer Action Network, the advocacy affiliate of the American Cancer Society and one funder of the study, stated in a news release. “States have a responsibility to ensure that all people in Medicaid have access to preventive care for a life-threatening disease such as cancer.”

For more information:

Wilensky S. Health Aff. doi:2013 10.1377/hlthaff.2013.0224.

Disclosure: The study was funded by the American Cancer Society, the American Cancer Society Cancer Action Network, the American Heart Association and the National Colorectal Cancer Roundtable.