The Affordable Care Act (ACA) emphasized the importance of preventive services to improve lives. Effective January 1, 2013, pursuant to Section 4106 of the ACA, states may receive a one percentage point increase in their federal Medicaid matching rate for preventive services if they cover without cost sharing all preventive services for adults (see Table A1) recommended by the ACA. The federally convened U.S. Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). At the time of the survey, four states had submitted State Plan Amendments (SPAs) to benefit from the 1% increase and since then, 4 additional states (8 total) have submitted SPAs for the match improved. States must cover preventive services for adults newly eligible for Medicaid under the ACA, but it is not required for the group of adults enrolled in or eligible for traditional Medicaid before the program’s expansion by the TO THAT. This brief highlights data from a survey of states. Medicaid programs conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) on coverage of recommended preventive services for nonelderly adults prior to enactment of the ACA., The survey asked states about coverage and cost sharing in their fee-for-service Medicaid programs as of January 1, 2013 for 40 adult preventive services rated “A” or “B” by the USPSTF and immunizations recommended by ACIP. The survey also asked about coverage of seven additional preventive services for women recommended by the Health Resources and Services Administration (HRSA) (see Table A2). A total of 39 states and the District of Columbia responded to the survey. Key findings include:
- While all individual preventive services were covered by most (28) state Medicaid programs in 2013, many states charged cost sharing for at least some of the services. Eight states (Figure 1) reported covering all 47 preventive services in this survey without cost sharing (California, Minnesota, Nevada, New Hampshire, New Jersey, New York, Oklahoma, and West Virginia).
Figure 1: Medicaid coverage of recommended preventive services for adults, January 2013
- Several other states are close to qualifying for the higher matching rate. Four states cover all services but charge cost sharing for at least one of the services. Sixteen other states cover at least 40 services but may require cost sharing for some.
- More than half of responding states reported covering all STI counseling and immunization services without cost sharing. Most also cover all pregnancy-related services, which are not subject to cost sharing. The majority of states reported covering all services in other categories subject to enhanced matching (cancer screening, health promotion, chronic disease), but several states charged cost sharing for at least one service (Figure 2).
- Each individual prevention service was covered by at least half, and in many cases two-thirds, of the reporting states.
Figure 2: Medicaid coverage of preventive service categories, January 2013
