Prevention of Chronic Disease

Title IV - Prevention of Chronic Disease and Improving Public Health of the Affordable Care Act promotes prevention, wellness and public health and supports health promotion efforts at the local, state and federal levels. Several provisions under Title IV expand access to health care services that help Medicaid beneficiaries prevent and manage chronic disease.

Areas of interest under this provision:

Preventive and Obesity-Related Services: Two provisions, Sections 4004(i) and 4106, encourage states to expand and promote coverage of evidence-based preventive services for adults. (Children are already entitled to preventive services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit).

• Sections 4004(i) and 4106 under Title IV Prevention Of Chronic Disease and Improving Public Health
• The goal of section 4004(i) is to educate Medicaid enrollees about the availability and coverage of Medicaid services with the goal of reducing obesity.  In order to meet this goal, CMS will provide guidance and information to states regarding the services available. States need to share coverage information through public awareness campaigns.  CMCS is also required to periodically report to Congress on the status and effectiveness of public awareness campaigns.
  • 4004(i) Qs and As
  • 2011 Report: Preventive and Obesity-Related Services Available to Medicaid Enrollees
• Section 4106 provides for an increased federal match to states that provide all of the U.S. Preventive Services Task Force (USPSTF) A and B recommended preventive services and ACIP approved vaccines and their administration. This provision took effect January 1, 2013.
  • State Medicaid Director Letter SMD#13-002 – 2/1/13
  • 4106 Qs and As

Tobacco Cessation for Pregnant Women: Section 4107 provides Medicaid coverage of tobacco cessation services, including counseling and pharmacotherapy, to pregnant women without cost-sharing. Covered services are those recommended by the 2008 Public Health Service (PHS) Clinical Practice Guidelines.

• Section 4107 under Title IV Prevention Of Chronic Disease and Improving Public Health
• State Medicaid Director Letter SDL#11-007 - 6/24/11
• CMCS Informational Bulletin - 6/29/11

Incentives for the Prevention of Chronic Disease: Section 4108 creates the Medicaid Incentives for Prevention of Chronic Diseases Program. This nationwide program will test and evaluate the effectiveness of a program to provide financial and non-financial incentives to Medicaid enrollees of all ages who participate in prevention programs to address at least one prevention goal.

• Section 4108 under Title IV Prevention Of Chronic Disease and Improving Public Health
• CMCS Informational Bulletin - 2/26/11
• Fact Sheet: Medicaid Incentives for Prevention of Chronic Diseases Grants - 9/13/11
• Website: Medicaid Incentives Program for the Prevention of Chronic Diseases

Questions about these provisions can be directed to: MedicaidCHIPPrevention@cms.hhs.gov

Other prevention-related provisions of the Affordable Care Act include:

Section 2703 – Health Homes. States have the option to create health homes to coordinate care for enrollees with chronic conditions, including enrollees who are overweight or obese.

Sections 2303 and 2001 – Family Planning. Establishes a new Medicaid eligibility group and the option for states to begin providing medical assistance for family planning services and supplies.