Prevention

Prevention Initiatives

Medicaid Prevention Learning Network. The Medicaid Prevention Learning Network provides an opportunity for state Medicaid programs to engage in state-to-state learning and receive enhanced technical assistance to improve delivery of preventive health care in Medicaid and CHIP. In 2015, CMS began forming affinity groups to focus on prevention topics of common interest to states.

• Antipsychotic Drug Use in Children (ADC) Affinity Group Fact Sheet
• Diabetes Prevention and Management Affinity Group Fact Sheet
• HIV Health Improvement Affinity Group Fact Sheet
• Tobacco Cessation Affinity Group Fact Sheet

Developmental and Behavioral Screening of Young Children Periodic developmental and behavioral screening during early childhood can identify possible delays in growth and development, when steps to address deficits can be most effective. These screenings are required for children enrolled in Medicaid, and are also covered for children enrolled in CHIP.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Through the EPSDT benefit, Medicaid-eligible children under age 21 are assured coverage for preventive and comprehensive health services. The EPSDT benefit includes screening, vision services, dental services, hearing services, and other services necessary to correct or improve health conditions discovered through screenings.

Immunizations. Medicaid plays a key role in the prevention of disease by facilitating access to vaccines and vaccine administration for children, adolescents and adults.  CMS and the Centers for Disease Control and Prevention (CDC) jointly run the Vaccines for Children program, which provides vaccines to Medicaid and CHIP-enrolled youth.

Maternal and Child Health. Prenatal, postpartum and neonatal care can affect the long-term health of both mother and child. In July 2014, CMS announced a new initiative to improve maternal and infant health outcomes. The Maternal and Infant Health Initiative is designed to improve the rate and content of postpartum visits in Medicaid and CHIP, and to increase access and use of effective methods of contraception among women in Medicaid and CHIP.

Obesity. Over the last 20 years, the prevalence of obesity has increased in every U.S. state. Because many preventable chronic diseases and other health problems are associated with obesity, the obesity epidemic presents an urgent public health challenge. Medicaid and CHIP provide access to screenings and interventions to reduce obesity and promote healthy eating and physical activity.

Oral Health. Oral health is an important part of overall health and prevention and early treatment of dental conditions can prevent future health problems. States are required to provide dental benefits to children covered by Medicaid and CHIP, but states choose whether to provide dental benefits for adults.

Tobacco Cessation. Smoking causes disease and reduces the overall health of smokers. Tobacco use treatment is one of the most cost-effective clinical preventive services. Medicaid programs may cover a wide range of benefits, including counseling, quitlines, and pharmacotherapy to help beneficiaries quit smoking. States are required to cover tobacco cessation services for pregnant women.

Affordable Care Act Provisions

Title IV of the Affordable Care Act identifies many specific ways the federal government will work with states and across agencies to expand access to preventive health care services. For instance,

Section 4004(i) requires states to design public awareness campaigns to educate Medicaid enrollees on the availability and coverage of preventive and obesity-related services. To support these efforts, the Centers for Medicare and Medicaid Services/Center for Medicaid and CHIP Services (CMCS), will provide guidance and information to states regarding the services available

• 4004(i) Qs and As
• 2011 Report: Preventive and Obesity-Related Services Available to Medicaid Enrollees
• 2014 Report Preventive Services and Obesity-Related Services Available to Medicaid Enrollees

Section 4106 provides that states who elect to cover all of the United States Preventive Services Task Force (USPSTF) grade A and B recommended preventive services, ACIP recommended vaccines and their administration with no cost-sharing shall receive an increased federal match for such services.

• State Medicaid Director Letter SMD#13-002 - 2/1/2013
• 4106 Qs and As

Section 4107 requires states to cover tobacco cessation services for pregnant women including counseling and pharmacotherapy as recommended by the Public Health Service 2008 Clinical Practice Guidelines.

• State Medicaid Director Letter SDL#11-007 - 6/24/11
• CMCS Informational Bulletin - 6/29/11

Section 4108 establishes a grant program for states to test and evaluate the use of incentives to help Medicaid and CHIP beneficiaries reduce blood pressure, improve cholesterol, lose weight, control diabetes and stop smoking.

For additional information and guidance about these and other prevention-related provisions in the Affordable Care Act, visit: http://www.medicaid.gov/AffordableCareAct/Provisions/Prevention.html

See also: "Prevention and Getting Care" on healthcare.gov

Questions about Medicaid and CHIP coverage of preventive health care services should be directed to: MedicaidCHIPPrevention@cms.hhs.gov

CMCS provides technical assistance to support state efforts to improve access to and quality of preventive health care services.

Medicaid Prevention Learning Network

The Medicaid Prevention Learning Network provides an opportunity for state Medicaid programs to engage in state-to-state learning and receive enhanced technical assistance to improve delivery of preventive health care in Medicaid and CHIP. In 2015, CMS began forming affinity groups to focus on prevention topics of common interest to states.

In 2016, CMS, the Centers for Disease Control and Prevention (CDC), and the Health Resources Services Administration (HRSA) launch the HIV Health Improvement Affinity Group. This group will bring together state public health and Medicaid and Children’s Health Insurance Program (CHIP) agencies to collaboratively improve health outcomes for Medicaid and CHIP enrollees living with HIV by identifying opportunities to strengthen the HIV Care Continuum among these populations. 

• HIV Health Improvement Affinity Group Fact Sheet
• HIV Health Improvement Affinity Group Expression of Interest Form

In 2016, CMS launched the Diabetes Prevention and Management Affinity Group. State Medicaid agencies interested in joining an interactive forum dedicated to improving diabetes prevention and management are encouraged to join.

• Diabetes Affinity Group Fact Sheet
• Diabetes Affinity Group Expression of Interest Form

In 2016, CMS launched the Antipsychotic Drug Use in Children (ADC) Affinity Group. State Medicaid agencies interested in conducting focus studies or implementing performance improvement projects related to antipsychotic utilization in children are encouraged to apply.

• Antipsychotic Drug Use in Children Affinity Group Fact Sheet
• Antipsychotic Drug Use in Children Expression of Interest Form

Preventive Services Rule Change

In this final rule, CMS revised the regulatory definition of preventive services at 42 CFR 440.130(c) to be consistent with the statutory provision at section 1905(a)(13) of the Social Security Act that governs preventive services. This change allows additional practitioners, who are subject to qualifications established by the state, to provide preventive services to Medicaid eligible beneficiaries. 

• Update on Preventive Services Initiatives Informational Bulletin
• Webinar Presentation Slides
• State Medicaid Manual, Chapter 4, Section 4385

A Tobacco Cessation Affinity Group began in 2015. State Medicaid agencies interested in improving utilization and quality of tobacco cessation benefits are encouraged to contact MedicaidCHIPPrevention@cms.hhs.gov to learn from the work of the affinity group.

• Tobacco Cessation Affinity Group Fact Sheet
• Affinity Group Expression of Interest Form