EPSDT Care for Kids Newsletter

EPSDT Care for Kids in Iowa, 1999
Sally Nadolsky, EPSDT Specialist
Division for Medical Services, Iowa Department of Human Services
Winter 2001

In FY 1999, more than 90% of Iowa children who were eligible for EPSDT Care for Kids services participated in the program. The highest rates of participation were found among infants in their first year, and among children from 6 to 14 years old. The age group that showed the lowest rate of participation was children between the ages of 1 year and 5 years.

The chart shows the percent of eligible Iowa children, grouped by age, who participated in at least one annual EPSDT screening each year from 1995 to 1999. Participation rates for 15- to 21-year-olds are high because, although the current Medicaid schedule calls for a health care visit every other year, most practitioners follow the Academy of Pediatrics schedule, which calls for yearly visits.

Percent of eligible children participating in the Iowa EPSDT Care for Kids Program
Year Age	1999	1998	1997	1996	1995
Birth to 1 year	89%	84%	84%	89%	80%
1 to 5 years	79%	93%	81%	65%	48%
6 to 14 years	89%	167%	74%	85%	49%
15 to 21 years	136%	208%	125%	158%	85%
Percent of all eligible children who participated	91%	122%	84%	83%	57%

Dental care. Participation rates in FY99 for dental screening was 38%. Although this is an increase from FY98, with a participation rate of 33%, access to dental care continues to be an issue for children in the state.

Children 1 to 5 years old. The participation rate for children between the ages of 1 year and 5 years fell below 80% last year; this is cause for concern because these early years lay the foundation for a child's future development.

Background
the annual EPSDT report to HCFA uses a variety of codes to capture preventative and treatment visits (referred to as initial or periodic screens) to a child's medical or dental home. The word eligible refers to the number of children enrolled in Medicaid for the fiscal year being measured.

The rate of participation in medical services is determined by dividing the number of eligible children who receive at least one initial or periodic EPSDT screen by those who are expected to receive at least one EPSDT screen. The formula adjusts the raw number of eligible children to account for those who move into and out of eligibility status during the year. The formula also adjusts for the number of screens expected, based on the periodicity schedule. (The quality or comprehensiveness of the screening itself is not assessed for this report.)

The participation rate for dental services is determined by dividing the number of eligible children who have at least one preventative or treatment visit to a dentist by the total number eligible for Medicaid during the year. This number is not adjusted by eligibility time frames.

This year the way that the annual participation of eligible children in EPSDT is calculated has been modified to improve the accuracy of Iowa's participation report, HCFA-416. Due to the methods used in past years to adjust the expected number of children eligible for a visit, participation rates sometimes exceeded 100%. For example, participation rates could include a number of adolescents who visit a physician yearly, while the expected number of visits, based on the periodicity schedule, was once every two years. The new formula for calculating participation rates will eliminate participation levels that exceed 100%.