Capitol Correspondence - 09.29.20

CMS Notes Dramatic Decline in Care for Children in Medicaid Due to COVID-19 – Including Disability Screening

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ANCOR is flagging this call to action by the Centers for Medicare and Medicaid Services (CMS) because some of the concerns it raises relate to child screening services that assess physical and cognitive development. These screening services can provide early detection of autism and developmental delay, among other conditions.

 “The Centers for Medicare & Medicaid Services (CMS) released preliminary Medicaid and Children’s Health Insurance Program (CHIP) data revealing that, during the coronavirus disease 2019 (COVID-19) public health emergency (PHE), rates for vaccinations, primary, and preventive services among children in Medicaid and CHIP have steeply declined. This decline may have significant impacts on long-term health outcomes for children, as Medicaid and CHIP cover nearly 40 million children, including three quarters of children living in poverty and many with special health care needs that require health services. Further, as many schools remain closed for in-person instruction, many of the key services children receive may be delayed, such as child screens and vaccinations prior to the start of the school year or in-school services such as speech therapy, physical therapy, and occupational therapy. Because preventative and routine healthcare is crucial to ensuring that children stay healthy, CMS is releasing this preliminary data to raise awareness of the vital services Medicaid and CHIP provides, and calling on stakeholders to take action to make services more readily available so that we can begin closing the gap in care for children.

A recent CMS data analysis reveals that, compared to the same time period in 2019, there was a significant decline in critical primary and time-sensitive preventative services for children between March and May. Specifically, during this timeframe, there were 22 percent fewer (1.7 million) vaccinations received by beneficiaries up to age 2, 44 percent fewer (3.2 million) child screening services that assess physical and cognitive development and can provide early detection of autism and developmental delay, among other conditions, even after accounting for the increased use of telehealth, and 69 percent fewer (7.6 million) dental services. Although this analysis only focuses on data through May 2020 because of the natural lag between when a service occurs and when CMS receives data, the precipitous decline in services remains a cause for concern. Not only must state and local agencies, providers, schools and other key stakeholders work on returning to prior year treatment levels, they must also strive to treat the millions of children who have already missed important medical services.

This is essential, as missing these services can have long-term negative impacts on children’s health outcomes.


While national data show that vaccination rates are increasing, the number of vaccines that have been administered so far this year have yet to make up for the large decline earlier in the year. To ensure that children catch up on their missed vaccines we need vaccination rates to not only approach those of 2019, but to be much higher, in order to mitigate the 22 percent dip during the early part of the COVID-19 PHE. This has not begun to happen, and increases the risk of transmission of vaccine-preventable illnesses, such as measles, mumps, and Haemophilus influenza. The potential for increased outbreaks of infectious disease due to decreased vaccinations is real, and can result in decreased school attendance, decreased learning, and increased childhood illness in general.

Although the start of the school season will be different for children as many begin their education in a virtual manner, the critical need for children to receive preventative and routine healthcare persists. It is important for schools and families to catch up on well-child visits and ensure that children are up-to-date on their immunizations.

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