New pre-pandemic data show children with Medi-Cal don’t access enough preventive care

California’s children covered by Medi-Cal Managed Care received alarmingly low levels of recommended preventive care in 2019, according to data newly released by the California Department of Health Care Services (DHCS).

DHCS released its first annual Preventive Services Report, which was developed in response to a California State Auditor Report that found millions of children do not receive all the preventive services they are entitled to. The report and addendum include 13 indicators of Medi-Cal managed care pediatric preventive service use in 2019. Key data related to infants and toddlers include:

Developmental Screening: Only 25% of children in Medi-Cal managed care were screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months before their first, second, or third birthday. (In our last blog about Medi-Cal data, we discussed new data available through the Centers for Medicare and Medicaid Services (CMS) Child Core Set. This showed the rate of developmental screening in Medi-Cal Fee-For-Services (FFS) and managed care to be similar at 22%).

Well-Child Visits: Only 26% of children in Medi-Cal managed care received at least six of the eight American Academy of Pediatrics (AAP) recommended well-child visits between 0 and 15 months. Furthermore, just 63% of children in Medi-Cal managed care received at least two of the three AAP recommended well-child visits between 15 and 30 months.

Lead Screening: 61% of children who turned 2 years old during the measurement year had a blood lead screening by their second birthday. The national Medicaid benchmark for this indicator is 73%.

A few indicators that were planned for this report, including immunization rates, were excluded because of data collection limitations due to COVID-19. The rates for these indicators are expected to be released in spring 2021.

The 2020 data on these metrics are likely to be worse, as we know many children missed essential care due to the pandemic. In December 2020, pediatric visits were down an estimated 24% nationally from pre-pandemic baselines, and in April 2020 the number of vaccination doses administered to California children dropped by more than 40%.

Even if rates return to normal as the state reopens, it’s clear that pre-pandemic access was never sufficient. California must pay special attention to pediatric service rates and consider multiple approaches to increase early childhood access to care. Strategies such as providing continuous Medi-Cal coverage until a child’s fifth birthday, and using the reprocurement of managed care plan contracts to improve oversight will be essential to moving the state beyond back to “normal.”