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Delayed care: AAP responds to report on drop in pediatric visits in Medicaid, CHIP :

September 28, 2020

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The AAP has responded to a recent “call to action” after a government analysis found millions of children from low-income families did not get vaccinations, screenings, mental health care and dental services in the early months of the pandemic.

New data from the Centers for Medicare & Medicaid Services (CMS) highlight a decline in services used by children covered by Medicaid and the Children’s Health Insurance Program (CHIP) in March through May this year compared to the same period last year.

The agency found:

  • 69% fewer (7.6 million) dental services rendered,
  • 44% fewer (3.2 million) child screening services that assess physical and cognitive development,
  • 44% (6.9 million) fewer outpatient mental health services and
  • 22% fewer (1.7 million) vaccinations up to age 2.

CMS called on stakeholders “to take action to make services more readily available so that we can begin closing the gap in care for children.”

In a  letter to the CMS administrator, AAP President Sara “Sally” H. Goza, M.D., FAAP, said the data reinforce what pediatricians have been saying all along: The COVID-19 pandemic is harming children, and there are troubling trends showing decreases in ambulatory care.

Dr. Goza offered immediate actions health officials can take to help close the gap in child visits, including policies to boost children’s enrollment in public coverage programs and ways to alleviate financial strains on pediatricians.

Pediatricians have seen and reported on declines in health visits for months — and across coverage type — which prompted the AAP to launch a campaign to encourage parents to take their children to the pediatrician even during the pandemic.

“We invite CMS to use its power to help amplify our messages to parents,” the letter states, adding: “As the federal agency responsible for the programs that cover nearly 40 million children, CMS is uniquely positioned to ensure children receive the care that they need under the programs it administers.”

Among the AAP’s suggestions are the following:

  • Expand the locus of concern to include children who do not have coverage. Even before the pandemic, 320,000 fewer children had coverage in 2019 compared to 2018, a decrease driven by large reductions in Medicaid and CHIP coverage without offsetting gains in other coverage types. CMS can fund and promote outreach and enrollment in Medicaid and CHIP to cover every eligible child.
  • Commit to immigrant families that it is safe to enroll their children in public coverage and take their children to the doctor.
  • If pediatricians cannot afford to remain open, children will continue to face barriers. CMS can issue guidance that state Medicaid programs can immediately require managed care plans to issue retainer payments to pediatric providers to maintain the delivery system. The Department of Health and Human Services (HHS) can distribute funds to states to increase Medicaid payments for pediatric services or distribute these funds directly to the providers.
  • HHS can rescind the decision to allow pharmacists to administer immunizations to children ages 3-18 years regardless of state laws. CMS can encourage childhood immunizations within the pediatric medical home by working with the AAP to promote the importance of families going to their pediatrician.

Dr. Goza also documented how pediatricians have shouldered substantial risks and burdens during the pandemic to ensure children can continue to access care safety, and that pediatric practices have faced serious financial distress.

“The billions of dollars allocated by Congress for the Provider Relief Fund have not effectively reached pediatricians,” the letter explained. “… We urge you to immediately address the shortfalls … and work with us to get financial relief to all pediatricians as soon as possible.”

The AAP is ready to collaborate with CMS on actions to counter the troubling trends of children missing vaccines, screenings and other important care, Dr. Goza concluded.

Campaigns ramp up

To increase awareness about children’s need for timely medical care during the pandemic, the AAP produced six public service announcements (PSAs) for distribution to thousands of TV and radio outlets. The 30-second PSAs in English and Spanish urge parents to call their pediatricians to get their children caught up on vaccines and other important health care, and to check in with their pediatrician if their child or teen is struggling emotionally.

The initiative follows the “Call Your Pediatrician” campaign launched in the summer. Pediatricians can use the materials on social media platforms. They also can repost or share the new PSAs to urge families to check in with their child’s doctor to get caught up.

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