Millions of the nation’s poorest, unhealthiest people that are current beneficiaries of Medicaid may not have access to the early detection and disease prevention services touted under the Affordable Care Act (ACA), according to
researchers at George Washington University.
The reason is that requirements to provide such services under the ACA pertain only to private insurers, Medicare and Medicaid expansion programs, a
report from Kaiser Health News says.
The George Washington University study found wide disparities in adult preventive services under existing Medicaid programs across the 50 states and overall confusion about which of those services are covered, the report notes. For instance, less than half of all states explicitly cover many of the most effective preventive services, including health diet and obesity counseling and screenings for cholesterol, high blood pressure, osteoporosis, diabetes and depression.
Also, individual doctors are typically left to decide what tests to perform, as Medicaid guidelines for preventive services are often not included in the programs, the report says. Further complicating matters, existing Medicaid rules often contained confusing language indicating that preventive testing and counseling would be denied without proof of “medical necessity,”—a term that by definition excludes preventive services.
For more on how to bill for Medicaid services under the ACA, turn to
Part B News.