The Affordable Care Act requires virtually all private insurance plans — including those offered through the ACA’s Medicare and Medicaid expansion program — to cover a wide range of preventive health screenings. After all, an ounce prevention is worth a pound of cure.
One of the primary reasons cited for passing the ACA was to make sure people had access to preventive care and chronic disease management, which are far less expensive than treating people in emergency rooms when they become acutely ill. To promote this, the U.S. Preventive Services Task Force came up with a list of preventive health screenings and important well visits that should and must be covered. Unfortunately, a new study has found that those services aren’t guaranteed to people currently covered through Medicaid, such as Social Security disability beneficiaries.
The study, which is published in the July issue of the health policy journal “Health Affairs,” points out that, nationwide, people with disabilities currently account for about 15 percent of those receiving health coverage through Medicaid. That includes many beneficiaries of Social Security Disability Insurance and Supplemental Security Income. The majority of Medicaid is paid for by the federal government, but it is administered by each individual state, and states can and do offer different Medicaid coverage from one another.
This group includes many of the poorest and sickest people in our nation. Nevertheless, the researchers found that the majority of states fail to cover all of the preventative services recommended for adults by the Preventative Services Task Force. Even in states that may cover preventive care under Medicaid the rules are often so unclear that they act as a barrier to that care.
The state-by-state rules vary widely. For example, the researchers found that almost every state Medicaid program covers mammograms, but only 36 states cover pap smears and fewer than half cover routine cholesterol screenings. In 12 states, well visits for adults are not covered at all, meaning that patients can’t see a doctor until they’re sick. As of 2010, according to the Henry J. Kaiser Family Foundation, Georgia’s Medicaid program covered less than 30 percent of the recommended preventive services for adults.
“Preventive services save lives by detecting diseases before they can progress,” said the study’s lead author. “Why should some Medicaid beneficiaries be left out when it comes to coverage for this kind of care?”
- Disability Scoop, “For Many With Disabilities, Health Screenings Still Not Covered,” Shaun Heasley, July 10, 2013
- Kaiser Commission on Medicaid and the Uninsured, “Coverage of Preventive Services for Adults in Medicaid,” The Henry J. Kaiser Family Foundation, September, 2013