State: Technical ‘reporting errors’ caused data gap on kids’ Medicaid referrals

MM Curator summary


A recent report showing GA failing to deliver EPSDT services at an alarming rate was based on bad data.


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State officials say “reporting errors” from the government led to recent data indicating that Georgia had a stunningly low rate of referring poor kids under Medicaid to specialty medical services.


“We’re certainly not below every single state” when it comes to referrals, Ryan Loke, deputy commissioner of the Department of Community Health, told the agency’s board earlier this month.

The agency investigated data under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program after Georgia Health News, citing a national analysis, reported that children covered by Medicaid weren’t getting their required “corrective treatments” at a rate comparable to those of other states.

The goal of EPSDT is to provide early detection and treatment of health conditions so that children and adolescents covered by Medicaid can get appropriate preventive, dental, mental health, developmental or other specialty services.

A report from the National Health Law Program compared states on their numbers of health screenings and referrals to specialized care. Georgia in 2019 had 1.4 million children eligible for EPSDT. The report’s figures showed the state was doing health screenings at recommended levels.

But just 30,000 Georgia kids that same year were referred to corrective treatment for a health condition, the report said.  That compared with Illinois, also with 1.4 million eligible kids, which referred more than 500,000 for services in 2019.

Community Health said in an email to GHN that the information technology system run by the state for Medicaid recorded tens of thousands fewer referrals than actually occurred.

Dan Young of the National Health Law Program (NHeLP), a nonprofit organization that generated the report, said the state’s explanation of the referral gap appears to make sense.

“I don’t know why the Georgia [Medicaid] information system isn’t capturing the correct data,” Young said.

He said the NHeLP report served to generate important questions about Georgia medical referrals, and he added that “hopefully it will encourage [state officials] to take notice of how they report data.”

The figures in the NHeLP report came from the federal Centers for Medicare and Medicaid Services, which gets its referral data directly as reported by state Medicaid programs.

A large majority of children in Georgia Medicaid are covered by managed care companies, known as care management organizations.

This story available through a news partnership with Georgia Health News.


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