CMS recently released a report on service use among children with Medicaid and CHIP during COVID-19. Perhaps the most newsworthy aspect of the report is that the data therein come from the much beleaguered Transformed Medicaid Statistical Information System (T-MSIS) that my colleague, Tricia Brooks, has been following since CMS announced it in 2013. The goal of T-MSIS is to have more publicly available information about beneficiary eligibility, beneficiary and provider enrollment, service utilization, claims and managed care data, and expenditure data for Medicaid and CHIP. It came about in response to multiple reports from GAO and others documenting the need for more timely, complete and comparable Medicaid data to effectively oversee the program, but it’s been very difficult to get off the ground.
While it’s exciting to see fruit from the T-MSIS tree, the data only confirm what we already know. As the Commonwealth Fund started reporting back in April, outpatient visits have declined dramatically during the COVID-19 pandemic and pediatric visits have been slower to rebound than other specialties. According the Commonwealth Fund’s April and August reports, pediatric visits were down by about 60% in April, about 40% in May and about 25% in July.
Telemedicine visits increased over the period, but not enough to make up for the drop in in-person visits. The Commonwealth Fund data are from a sample of ambulatory practices and include outpatient visits for Medicaid, Medicare, and private insurance, from February through August 2020.
The CMS data, comparing Medicaid service utilization between March through May 2020 to March through May 2019, show the same troubling trends. About 44% fewer (3.2 million) child screening services were delivered March-May 2020 compared to 2019, with some states rebounding faster than others but all still reporting child screening rates well below January levels. The CMS data offer more detailed information about dental services for children during the pandemic than we’ve seen previously, with a drop in dental services of about 69% over the period studied. The data also show more detail on the decline in mental health visits for children, with wide variation among states. Like the Commonwealth Fund reports, the CMS data show a big increase in telehealth (2,500% from February to April 2020), but not enough to offset the decline in in-person visits.
With respect to childhood immunizations, the CMS data are consistent with earlier reports from the CDC showing a steep decline in vaccination rates early in the pandemic. Between March-May 2020, about 22% fewer (1.7 million) vaccines for children up to age 2 were delivered compared to the same period in 2019. Some states have reported immunization rates in even greater detail, such as this report from Pennsylvania with breakdowns by age that the Pennsylvania Partnerships for Children and the PA Chapter of the American Academy of Pediatrics are using to promote the importance of continuing to seek critical pediatric care.
The CMS data also offer a preliminary look at COVID-19 testing and treatment services for children in Medicaid and CHIP, with more than 250,000 tests delivered and about 32,000 children receiving COVID-19 treatment as of June 2020.
I hope that this report is just the beginning for T-MSIS, and that soon we’ll have even more data to help us understand how Medicaid and CHIP are serving children. But I think it’s equally important to point out what is missing from this report – just last week the US Census Bureau released deeply troubling data documenting the decline in health coverage for children between 2018 and 2019. It is notable that CMS did not highlight this important and troubling news – uninsured children have far more difficulties in accessing needed care under any circumstances. We will have more to come on this in our forthcoming annual report on the state of children’s coverage.
And there’s been no movement in the Senate on meaningful COVID relief since the spring. States are facing enormous budget shortfalls and may be forced to make draconian cuts to programs that are critical for families such as Medicaid, K-12 and higher education, services for people with disabilities, and services for people experiencing homelessness. States need an even larger FMAP increase to help prevent these types of cuts.
Policymakers should be doing everything in their power to give families across the US much needed peace of mind – reducing the burden to enroll in Medicaid and CHIP and access nutrition, housing and unemployment assistance programs. Instead, we’re in the final countdown to avoid a partial government shutdown in just 5 days. Children face many challenges – especially those living in communities of color. The federal government should be leading the way, giving states additional funding and providing support on how to respond to this pandemic. Instead, the Administration is issuing an “urgent call to action” for everyone else.